Affiliations: [a] KSVGH Originals and Enterprises, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan | [b] Department of Engineering and Maintenance, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan | [c] Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan | [d] Department of Aeronautics and Astronautics, National Cheng Kung University, Tainan 70101, Taiwan | [e] Department of Electrical Engineering, National Chin-Yi University of Technology, Taichung 41170, Taiwan | [f] Department of Electrical Engineering, Kao-Yuan University, Kaohsiung 82151, Taiwan
Correspondence:
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Corresponding author: Chung-Dann Kan, Division of Cardiovascular Surgery, Department of Surgery National Cheng Kung University Hospital, College of Medicine, National Cheng University, Tainan 70101, Taiwan. E-mail: kcd56@mail.ncku.edu.tw.
Abstract: Vascular access stenosis and venous needle dislodgement (VND) are frequent and serious life-threatening complications during hemodialysis (HD). According to dialysis survey reports, these complications are key issues for nephrology nurses, medical staff, and patients. Existing detection techniques and early warning tools provide promising solutions in these issues. However, these methods cannot screen for stenosis and VND complications during HD. Clinical examinations show that increases in transverse vibration pressure (TVP) are highly correlated with stenosis screening in arterial anastomosis sites (inflow needle); conversely, TVP drops in the event of a blood leak or VND in venous anastomosis sites (outflow needle). As an early-warning implementation, this study proposes a combination of fractional order integrator (FOI) and info-gap (IG) decision-making to detect these complications. FOI is used to calculate the TVPs’ area under curve (AUC), while AUC ratio (AUCR) quantifies the differences in TVPs between the normal condition and pressure sensor reading. An estimated function of the two-point form shows that AUCRs have a high correlation with TVP variations. Therefore, AUCR is employed to identify changes in TVPs and arrange specific allocations. The IG decision-making scheme produces inference profiles with specific allocations to separate the normal cases from vascular access stenosis or VND/blood leakage. The test results obtained from practical experiments were validated and compared with the results obtained using existing methods such as acoustic techniques, warning products, and homodynamic analysis. The findings also show that the proposed framework employing pressure sensors can be implemented in an early warning monitor for clinical and telemedicine applications.
Keywords: Life-threatening complication, fractional order integrator (FOI), info-gap (IG) decision-making, transverse vibration pressure (TVP), area under curve ratio (AUCR)
