#4500 IMPLEMENTATION OF A NEW GENERATION DIGITAL STETHOSCOPE FOR ARTERIOVENOUS FISTULA MONITORING IN HEMODIALYSIS PATIENTS

Abstract Background and Aims The management of complications arteriovenous fistula (AVF) for hemodialysis, principally stenosis, remains a major challenge clinicians with substantial impact on health resources. Stenosis not infrequently preludes to thrombotic events the loss AVF functionality. A frequent monitoring physical examination is at basis an appropriate clinical care. It includes regular inspection, palpation auscultation arm. normally functioning AVF, when listened by stethoscope, has continuous systolic-diastolic low-frequency murmur while stenosis frequency increases duration diastolic component decreases, disappearing in severe stenosis. These evidences are strictly subjective dependent from operator skill experience. New generation digital stethoscopes able record sound subsequently dedicated software allows extract quantitative variables (amplitude frequency) that characterize absolutely objective repeatable way. aim our study was analyze listenable AVFs taken commercial stethoscope investigate potentiality develop new system detect Method Between September 2022 January 2023, we screened forty-eight patients two hemodialysis centers Catanzaro (Italy). Patients were blinded experienced examiners recognized criteria doppler ultrasound (DUS). We recorded coming using 3M™ Littmann® CORE Digital Stethoscope 8570 (Figure 1-A), standardized sites: anastomosis chamber, distance 5 10 cm it, site immediately after. waves transformed into analysis software. Results Based evaluation, 14/48 (29%) classified as stenotic which three hemodynamically significant. sounds detected sites had significant higher average compared non-stenotic 1-B). Characteristics different term power, mean amplitude frequency. Analysis permitted us determine peculiar shape another normal 1-C,D). Conclusions distinguish between no AVFs. standardization this technique introducing data deep learning algorithm could allow fast method AVF.