HeRO (Hemodialysis Reliable Outflow) Graft is a fully subcutaneous device implanted by a surgeon that provides continuous blood flow directly from an artery into the central venous system. HeRO Graft is FDA classified as a vascular graft prosthesis and is cannulated like a conventional upper arm graft. Follow KDOQI Guidelines for cannulation.
- LOOK for a uniform sized graft in the upper arm with NO irregularities or aneurysm formations.
- LISTEN for low pitch, continuous diastolic & systolic flow. HeRO Graft bruit may be softer due to absence of a venous anastomosis.
- FEEL the thrill. It will be strongest at the arterial anastomosis, but can be felt over the entire course of the graft. HeRO Graft should be easy to compress; however, note that HeRO Graft thrill may be less prominent due to the elimination of the venous anastomosis.
- Never cannulate the HeRO Graft Venous Outflow Component
- To reduce potential infection, remove bridging catheter immediately post successful HeRO Graft cannulation
KDOQI Graft Cannulation Guidelines:
- Aseptic technique should be used for all cannulation
- Grafts generally should not be cannulated for at least two weeks after placement
- Swelling should have subsided so that palpation of the course of the graft can be performed
- Rotation of cannulation sites is needed to avoid pseudoaneurysm formation
HeRO Graft Considerations:
- A light tourniquet may be used to slightly dilate the graft
- Cannulate 3″ (8 cm) from the connector incision to avoid damage to the graft rings
- Follow dialysis unit protocol for cannulation distance from the arterial anastomosis incision
- If cannulating toward the anastomosis incision, stay at least the length of the fistula needle from the incision site
- Avoid the use of fistula clamps for hemostasis
Recognizing HeRO (Hemodialysis Reliable Outflow) Graft Patients:
HeRO Graft patients will typically have 3 incision sites:
- Venotomy site usually near the neck
- Connector site usually near the shoulder
- Arterial anastomosis site usually on the upper arm near the elbow or axilla
A HeRO Graft Patient Identification Card is also provided to patients following implant.
- Care & Cannulation Brochure (English Version)
- Care & Cannulation Brochure (Spanish Version)
The HeRO Graft is intended for use in maintaining long-term vascular access for chronic hemodialysis patients who have exhausted peripheral venous access sites suitable for fistulas or grafts. See the Instructions for Use manual for full prescribing information.