Levin N W, Yang P M, Hatch D A, Dubrow A J, Caraiani N S, Ing T S, Gandhi V C, Alto A, Davila S M, Prosl F R, Polaschegg H D, Megerman J
Renal Research Institute, New York, New York, USA.
ASAIO J. 1998 Sep-Oct;44(5):M529-31. doi: 10.1097/00002480-199809000-00042.
A new subcutaneous device (Dialock; Biolink Corp., Middleboro, MA) provides vascular access to patients who currently require hemodialysis (HD). The device consists of a port-like valve, implanted subcutaneously below the clavicle, which provides a linear flow passage to two catheters placed in the right atrium via the jugular vein. The valve is accessed percutaneously with needle-cannulas that functionally convert the device to twin catheters for connecting the patient to the HD lines. Interdialytic patency is maintained using a standard heparin lock. The device has been implanted in 10 outpatients under local anesthesia, with almost immediate use for HD (median, 3 days) and has functioned successfully for more than 6 months (mean +/- SD, 4.0 +/- 1.7; > 400 dialysis sessions). Blood flows over 300 ml/min were consistently achieved (average, 320 +/- 50) with venous and arterial pressures of 197 +/- 42 mmHg and -241 +/- 31 mmHg, respectively. After 40 patient-months, condition of the needle puncture sites remains satisfactory. Four systemic infections have occurred in three patients; all have resolved without the need for device removal. There have been no infections at the puncture sites. One patient whose heparin lock was not changed for 23 days (for reasons unrelated to the device) required fibrin sheath stripping of his catheters. Patient and nurse acceptance has been excellent. The device may offer substantial improvement over conventional devices for HD access.
一种新型皮下装置（Dialock；生物链接公司，马萨诸塞州米德尔伯勒）为目前需要血液透析（HD）的患者提供血管通路。该装置由一个类似端口的瓣膜组成，植入锁骨下方的皮下，通过颈静脉为置于右心房的两根导管提供线性流动通道。使用针套管经皮进入瓣膜，在功能上将该装置转换为双导管，以便将患者连接到血液透析管路。使用标准肝素封管维持透析间期的通畅。该装置已在局部麻醉下植入10名门诊患者体内，几乎可立即用于血液透析（中位时间为3天），并已成功运行超过6个月（平均值±标准差，4.0±1.7；超过400次透析治疗）。始终能实现超过300 ml/min的血流量（平均为320±50），静脉压和动脉压分别为197±42 mmHg和-241±31 mmHg。经过40个患者月后，针刺部位的情况仍令人满意。3名患者发生了4次全身性感染；所有感染均已痊愈，无需移除装置。穿刺部位未发生感染。1名患者（因与该装置无关的原因）23天未更换肝素封管，需要对其导管进行纤维蛋白鞘剥脱。患者和护士的接受度都很高。与传统的血液透析血管通路装置相比，该装置可能有显著改进。
