NEW ACCESS DEVICE FOR HEMODIALYSIS

A new subcutaneous device (Dialock(TM); Biolink Corp., Middleboro, MA) provides vascular access to patients who currently require hemodialys is (HD). The device consists of a port-like valve, implanted subcutane ously below the clavicle, which provides a linear flow passage to two catheters placed in the right atrium via the jugular vein. The valve i s accessed percutaneously with needle-cannulas that functionally conve rt the device to twin catheters for connecting the patient to the HD l ines. Interdialytic patency is maintained using a standard heparin loc k. The device has been implanted in 10 outpatients under local anesthe sia, with almost immediate use for HD (median, 3 days) and has functio ned successfully for more than 6 months (mean +/- SD, 4.0 +/- 1.7; > 4 00 dialysis sessions). Blood flows over 300 ml/min were consistently a chieved (average, 320 +/- 50) with venous and arterial pressures of 19 7 +/- 42 mmHg and -241 +/- 31 mmHg, respectively. After 40 patient-mon ths, condition of the needle puncture sites remains satisfactory. Four systemic infections have occurred in three patients; all have resolve d without the need for device removal. There have been no infections a t the puncture sites. One patient whose heparin lock was not changed f or 23 days (for reasons unrelated to the device) required fibrin sheat h stripping of his catheters. Patient and nurse acceptance has been ex cellent. The device may offer substantial improvement over conventiona l devices for HD access.