Abstract
A new subcutaneous device (Dialock®, Biolink Corp, Middleboro, MA) provides vascular access to patients who require hemodialysis. The device consists of a port implanted in a subcutaneous pocket in the thoracic area 10 cm below the clavicle. Interdialytic patency is maintained using a priming antithrombotic solution. The device was implanted in 10 outpatients under local anesthesia, and immediately used for hemodialysis. The catheters have been used up to now for a total of 1,480 days (24- 248 days), the average being 4.8 months (1–8 months). Survival rate of Dialock® was 100% at 8 months. During this period, the device achieved prescription hemodialysis blood flow rates averaging 250–300 ml/min with a venous pressure of 180 ± 25 mmHg. Malpositioning of the catheters due to their excessive length was observed in the first three patients and led to the repositioning of the catheters’ distal tips under local anesthesia. Secondary and delayed hematoma surrounding the Dialock® device were observed in 2 patients one or two days after insertion. In one case, a hematoma was surgically removed under local anesthesia. Antibiotic therapy was administered for safety and prophylactic reasons. In one patient spontaneous catheter fracture and distal tip embolization occurred on the 49th day after repositioning. Percutaneous radiological retrieval of the catheter fragment was performed.
No infection of the Dialock® device occurred and only one episode of bacteremia was observed. Blood cultures were positive for Staphylococcus epidermidis. Infection was cured by appropriate systemic antibiotic therapy combined with gentamicin and sodium citrate lock.
The device was well accepted by patients and staff. The Dialock® device catheter offers a new vascular alternative for dialysis that deserves further long-term study. In particular, the confidence of structural materials should be tested.
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