HeRO, (Hemodialysis Reliable Outflow) is a fully subcutaneous device implanted by a surgeon that provides continuous blood flow directly from an artery into the central venous system. HeRO is FDA classified as a graft and is cannulated like a conventional upper arm graft. Follow KDOQI Guidelines for cannulation.

Pre Cannulation Assessment:

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 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 should be easy to compress; however, note that HeRO thrill may be less prominent due to the elimination of the venous anastomosis.

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 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
  
• Remain 1.25" (3 cm) from the arterial anastomosis incision
• Avoid the use of fistula clamps for hemostasis

Recognizing HeRO (Hemodialysis Reliable Outflow) Patients:

HeRO 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

Patients may also receive any or all of the following at implant:

• HeRO Temporary Tattoo on implant-side wrist
• HeRO Identification Bracelet
• HeRO Patient Identification Card

Care & Cannulation Brochure (English Version)

Care & Cannulation Brochure (Spanish Version)

INTENDED USE

The HeRO Vascular Access Device 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.

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