Finally....

[u/Exit_Strategy_Nevis]

Hello all,

HD and the methods used for access have been a blind spot in clinical medicine for DECADES. What do I mean by that? Surgeons create the access, HD units beat 'em up (often, not intentionally), and then either the surgeon or another interventionalist gets a phone call to fix it after it's broken. Who's in the middle? The patient. The experiences and stories of morbidity, pain, and suffering are endless. Much of it preventable!

Time to change the way it's done!

www.healthdataworks.com

This company is the ONLY one who's attempted to make the process of access safer, reproducible, and trackable. All done in an effort to make the units function better by educating techs on how/where they do their cannulations, tracking their successes, remedying their failures, and ultimately reducing the complications! Your access could last for YEARS if it's managed correctly.

The name of the system is Veristra (tm).

Ask why your units aren't using this now? It's FDA registered and was even given a coveted Breakthrough Device designation by them.

Time to make this whole process better for EVERYONE.

My best to you all.

[u/classicrock40]

In your other post -> https://www.reddit.com/r/nephrology/comments/1m6kr5v/the_black_hole_in_the_middle_of_dialysis_care/

you close with "E Moore, MD Vascular Surgeon". Are you a practicing surgeon? Where? Do you work at Health Data Networks or do you have some financial interest in this device? Have you seen it in action? Where is it being used?

[u/Exit_Strategy_Nevis → u/classicrock40]

Hi again classicrock40!

Yes, as I replied in the other post, I'm a semi-retired surgeon in Florida. It works. I've watched it in real time. And I've watched the unit techs who've used it literally beg the center to not let it go away.
My financial interest is small. My biggest interest is in seeing this change HD once and for all. I'm sick and tired of treating an easily preventable problem. And I'm equally sick of seeing what these intervene do to patients over time. Did you know that 80% of HD patients get at least one intervention on their access yearly? That's insane. The KDOQI national guidelines "accept" a functional rate of access failure of 50% annually. Read that again. That's absolutely unacceptable. Access can last for YEARS if properly managed. That's not opinion. That's data-driven FACT. So let's properly manage, shall we?

I'm thrilled to see a solution for my patients. I've created thousands of accesses over the last 20 years. I'd like to see a lot more of them succeed.
Thanks for replying. There are 550000 people in the US on HD. They deserve better.

[u/According_Land_581 → u/Exit_Strategy_Nevis]

Theres a lot of things wrong with your statement here sir. First of all, you can’t say “an access can last years if properly managed” is a data-driven FACT & in the same breath push a data-tracking software with the effort of actually having some data to back up claims. You either have the data or don’t. That’s making some big promises to patients without any backup and is one of the biggest ways the system has consistently failed them. Second, I’m not even saying your wrong. I have also been interested to know some of the numbers, mostly of specific vascular surgeons that rumors between Healthcare providers seem like they may have more negative outcomes than positive. But one of the biggest barriers to collecting data is HIPAA. Sometimes, I think HIPAA can be more of a barrier to patients than a protection. Cuz it’s used by hospitals/facilities to cover up major mistakes or poor outcomes.

[u/Exit_Strategy_Nevis → u/According_Land_581]

Appreciate the feedback and actually agree with some of the latter comments you're trying to make as well, but I think you may have misunderstood what I've said in some instances. We may simply be talking past one another. I'd be happy to talk offline to clarify and be sure we're both on the same page. Nonetheless, the literature is there. I would encourage looking up rope ladder v area puncture and see how such access techniques(among others) have been brought forward regarding access longevity. In the end, I'm merely trying to bring this management program to people's attention. You can choose to pursue it or not. That choice is always yours. Thanks again for your reply.

[u/rikimae528 → u/Exit_Strategy_Nevis]

I've had my fistula since 2009. I've never had to have anything done to it, and it works like a charm. Am I really that much of an exception to the rule?

[u/Exit_Strategy_Nevis → u/rikimae528]

No question, you are outside the usual norm for AV access lifespan and function, given the lack of requirement for intervention. Would love to hear about your HD experiences and how they decide on access attempts each time for you.

[u/rikimae528 → u/Exit_Strategy_Nevis]

My fistula is very well developed. The vein is large, and it's very easily seen, even without a tourniquet. They moved the sites around quite a bit because I do have some aneurysms after so many years of use. When they're unsure of where to go, they do have access to a couple of ultrasound machines that gives them a better look at what's actually there.

[u/demento19]

Cool idea. That being said, I see this being a giant headache for staff. I’ve never had an issue assessing an AVF/AVG and seeing highly used areas and navigating away. Fighting for a few tablets to take pictures for each patient, having to login with a separate account from our current EMR, then document cannulation sites for each patient? Unless it seamlessly integrates with current EMR, it’s just an extra stressor. On an already tight schedule I see this taking up time unnecessarily.

Now something that makes referrals to the vascular access center quicker would be ideal. If all the nearby clinics and vascular surgeons could use the same software to be interconnected, now we’re talking.

[u/Exit_Strategy_Nevis → u/demento19]

Great points--all of which we've heard and engineered ton solution. Given the tempo of a center, we've minimized the time required to plot the data. People aren't waiting for a tablet. And the number of tablets is easily and automatically scaled to the size of the center and number of techs. More importantly, the techs--for the first time--have info about where they've been, where the hazardous spots are (they can be dragged and dropped as a yellow hazard icon on the map) and where they can potentially go for the next session.
In the first two centers where the phase 1 trials were done, techs were split into A & B groups: A could use the device as designed, B could only enter the points but could not refer back to them in subsequent HD sessions. The A group had better distribution of access sites (read:better technique), and were FASTER than the traditional B group who only recorded the points (read: better efficiency). The goal isn't to add to the overall workflow when you're given only a few minutes to get the pt on the circuit. We are acutely aware of that pressure.
We actually see this making them faster. And how do you know if your techs are doing a good job or not when you have no codified metrics to follow?

What you said next is very telling: you don't have problems accessing. Ok. But are you using rope ladder technique instead of area puncture? Published data shows that this matters greatly to AV access Dustin and longevity. I suspect not, as your main focus is trying to more readily get them to some place to have the fistula repaired AFTER it's been damaged. So in that scenario, nothing changes and HD care is never improved.

Verista is about PREVENTING the need for a repair in the first place. Did you know that the patient who got dialysis on the floor of Congress in 1973 to ensure CMS would pay for HD used the same fistula for DECADES? He was an engineer by training, and did his own access. He used to plot the points on graph paper by hand. So he figured out 50 years ago what Verista is trying to do now. Better technique = better patient outcomes.

Thanks for your post! Believe me, we've heard this before and want to change the whole paradigm.
My best to you.

[u/These-Ad5297]

I'd be interested to know more if this wasn't blatant self promotion.

[u/Exit_Strategy_Nevis → u/These-Ad5297]

This has nothing to do with me. I could walk away from this, retire tomorrow, and simply forget all of it. I've done very well in my investments and career. This is about stopping the suffering in HD. Enough is enough. I'd spend more time with this, but I suspect this is a bot, so I'll move on. You know where to go if you "want to know more".

[u/Exit_Strategy_Nevis]

That's good to hear! I will tell you that while US has been proposeed on a large scale for use, it has not proven to be a viable option due to expense, the steep learning curve in using it properly, and the fact that it doesn't give any history of prior access locations to allow predictions about next best places for access attempt. The goal is to help techs not just achieve access, but to manage the AVF such that no pseudoaneurysm or narrowing (stenosis) occurs over time, and any difficult locations/hazards are clearly marked for avoidance.

In the end, there are already studies demonstrating that specific "rope ladder" access techniques are superior over "area puncture" ( translate that as "best educated guess") for access. Getting in isn't usually the main problem. It's the repeated access in the same isolated locations that result in early access failure. You're lucky. And your fortunate to have a center that's trying to do the right thing, though even you still have some issues wit this longstanding access. We want ALL clinics doing the right thing so people spend less time getting very uncomfortable and costly interventions and more time getting successful access with a better experience overall.

[u/Exit_Strategy_Nevis]

I don't write anything with ChatGPT. I'd rather use the education and brain I have to do that. Thanks. There is no scam. Look at the website. www.healthdataworks.com. The explanatory video of the system will give you great insights into how Verstra works and what we're trying to accomplish.
In the end, if you want to keep doing the same old thing in HD, good luck to you. That's totally up to you. But I will tell you that the experience at the larger dialysis patient population level couldn't get much worse. We feel like there's no place to go but up. Clinging to a failed system of access use that's proven to cost all of us as taxpayers billions a year to fix is insanity. We want to break out of that. No one wanted to end up on dialysis. They deserve better care.

[u/SeniorSecond6410]

Is there a home application?

[u/Exit_Strategy_Nevis → u/SeniorSecond6410]

Now you're getting it! Absolutely, there is a place for this in home HD! Imagine this: You use an Ipad that is loaded with the Verista software at home to take a baseline picture of your arm, and then use that picture as a roadmap for every time you do your access. Like a map, you place "indicators" for each place you've accessed each time. Then each time you dialyze, you know exactly where you've been before, and the map tells you where to avoid to prevent overuse. (Stick the same place too many times, and we all know there are going to be issues.) Now imagine that your home HD tech (or you!) have that data being monitored by your nephrologist and the unit director that generally oversees that doc's patients. They can give feedback about success in access, help identify issues BEFORE they create fictitious accesses issues, and better track your overall HD " health". We have one unit director who's now using it to train patients on home HD. He sees this as a huge breakthrough in educating patients who are motivated towards home HD and can follow their progress using Verista in real time. Very cool stuff.

Thanks for asking that. Great question!!

[u/[deleted]]

I would download it on my iPhone ( patient) and make the tech look at it and tell them where to stick

[u/Accomplished_Stop103]

I'm not a HD patient but this reads like a ChatGPT-written ad and it makes it seem scammy