A new subcutaneous device (Dialock(R), 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 he-modialysis. 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 (R)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(R)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 (R)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 (R)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.