Introduction: By offering a rapid and convenient vascular access option for hemodialysis, permanent catheters are increasingly used in ESRD patients. Indeed, permanent catheters are associated with an increased risk for complications. Moreover, catheter bearing spoils the self body image and may alter the quality of life of dialysis patients. Implantable port catheter device, recently introduce in dialysis, may offer an attractive option, able to reduce most of infectious risk and inconveniences of the permanent catheters.
Patient and material: The Dialock (Biolink) device was evaluated in a multicenter French trial. Twelve dialysis facilities enrolling 51 ESRD patients (male 28, female 23, age 56 +/- 2 years) participated in this trial. Dialock devices were inserted in patients for whom a permanent venous catheter was indicated. The cumulative experience was 56.8 years-patient. The technical survival (intent to treat) of Dialock devices was 85% at two years. Blood flow were 299 +/- 7 ml/min. Dialysis adequacy was achieved in all patients without altering dialysis schedule (3 sessions per week, 240 +/- 30 min each). Dialysis dose (K(/Vdp) delivered was 1.3 +/- 0.2. Satisfaction of patients and nursing staff was achieved in 75% of cases. Normalized incidence of complications (events for 1000 patient-days) in the evaluation phase (II) were as follows: hematoma and/or small bleeding (2.1), bacteremia (1.1), device infection (0.2), skin necrosis (0.1). A significant reduction of the infection and hematoma incidence rate was noticed when heparin lock was substituted for an non hemorrhagic antithrombotic locking solution (fragmented heparin or sodium citrate). This observation tend to accreditate the hypothesis that port catheter infection occurs via a transluminal bacteria passage.
Conclusion: The Dialock device, offers a new and comfortable hemodialysis vascular access for ESRD patients. Performances are in agreement with those needed to achieve adequate dialysis. The regular use of dual antithrombotic-antiseptic catheter locking solution seems to be necessary to prevent any bacterial contamination.