Nephrology Dialysis Transplantation, Vol 14, Issue 3 692-698, Copyright © 1999 by Oxford University Press
B Canaud, H My, M Morena, B Lamy-Lacavalerie, H Leray-Moragues, J Bosc, J Flavier, P Chomel, H Polaschegg, F Prosl and J Megerman
Background. Vascular access, a vital tool for
end-stage renal disease patients, remains a weak component of
extracorporeal renal replacement therapy (RRT) and the first cause of
morbidity. Permanent catheters proposed as an alternative to permanent AV
fistulae are associated with a significant risk of infection. A
subcutaneously implantable chamber connected to permanent catheter appears
highly desirable to reduce such hazards. Methods.
Dialock®, a metallic port-like valve device connected to
permanent silicone twin catheters has been developed (Biolink Corp,
Middleboro, MA, USA). After being implanted subcutaneously below the
clavicle, Dialock provides a linear flow passage to two Silastic catheters
placed in the right atrium via the right internal
jugular vein. The valve is accessed percutaneously each dialysis session
with needle cannulae that functionally convert the device into twin
catheters. Interdialytic patency of the catheters is ensured by
antithrombotic lock (heparin or low-molecular-weight heparin).
Results. Dialock was implanted in 10 ESRD patients
(64±12 years) under general anaesthesia, with almost immediate
use for HD. RRT consisted of three HD sessions per week lasting 4 h; 699 HD
sessions were performed. Average duration of use was 5.7 patient-months
(1.3-9.6 months). Patient satisfaction was evident in all cases. Three
episodes of bacteraemia occurring in the early phase of the study were
cured by appropriate antibiotics. No device was removed because of
infection. Skin condition at the puncture sites has remained satisfactory
in all patients. Nurse training for cannulating was brief (2-3 x).
Effective blood flow was 307±3.3 ml/min, with a venous pressure
of 195±39 mmHg and a recirculation rate of 6.7±0.8%.
Effective Kt/V dp delivered was 1.36±0.03 with a nPCR of
1.20±0.005 g/kg/day. Haematoma and a small amount of bleeding of
the skin puncture sites observed in the initial period of the study were
effectively prevented by reducing heparin lock volume.
Conclusions. The Dialock device offers a new and
interesting vascular access alternative for haemodialysis bridging the
'gap' between permanent catheters and arteriovenous fistulae. Dialock's
place in the vascular access strategy for haemodialysis patients deserves
further long-term clinical studies. Keywords:
end-stage renal failure; haemodialysis; implantable chamber;
permanent catheter; vascular access
ORIGINAL ARTICLES
Dialock: a new vascular access device for extracorporeal renal replacement therapy. Preliminary clinical results
Nephrology and AIDER, Lapeyronie University Hospital, Avenue du Doyen G Giraud, F-34295 Montpellier, France; Nephrology, St Joseph Hospital, Lyon, France; Biolink Corporation, Middleboro, MA, USA; Corresponding author
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