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H My

Publications and source records attributed to H My.

8 recordsLinked to original sources
PubMed1999

Dialock: a new vascular access device for extracorporeal renal replacement therapy. Preliminary clinical results.

BACKGROUND: Vascular access, a vital tool for end-stage renal disease patients, remains a weak component of extracorporeal renal replacement therapy (RRT) and the first cause of morbidity. Permanent catheters proposed as an alternative to permanent AV fistulae are associated with a significant risk of infection. A subcutaneously implantable chamber connected to permanent catheter appears highly desirable to reduce such hazards. METHODS: Dialock, a metallic port-like valve device connected to permanent silicone twin catheters has been developed (Biolink Corp, Middleboro, MA, USA). After being implanted subcutaneously below the clavicle, Dialock provides a linear flow passage to two Silastic catheters placed in the right atrium via the right internal jugular vein. The valve is accessed percutaneously each dialysis session with needle cannulae that functionally convert the device into twin catheters. Interdialytic patency of the catheters is ensured by antithrombotic lock (heparin or low-molecular-weight heparin). RESULTS: Dialock was implanted in 10 ESRD patients (64+/-12 years) under general anaesthesia, with almost immediate use for HD. RRT consisted of three HD sessions per week lasting 4 h; 699 HD sessions were performed. Average duration of use was 5.7 patient-months (1.3-9.6 months). Patient satisfaction was evident in all cases. Three episodes of bacteraemia occurring in the early phase of the study were cured by appropriate antibiotics. No device was removed because of infection. Skin condition at the puncture sites has remained satisfactory in all patients. Nurse training for cannulating was brief (2-3 x). Effective blood flow was 307+/-3.3 ml/min, with a venous pressure of 195+/-39 mmHg and a recirculation rate of 6.7+/-0.8%. Effective Kt/V dp delivered was 1.36+/-0.03 with a nPCR of 1.20+/-0.005 g/kg/day. Haematoma and a small amount of bleeding of the skin puncture sites observed in the initial period of the study were effectively prevented by reducing heparin lock volume. CONCLUSIONS: The Dialock device offers a new and interesting vascular access alternative for haemodialysis bridging the 'gap' between permanent catheters and arteriovenous fistulae. Dialock's place in the vascular access strategy for haemodialysis patients deserves further long-term clinical studies.

Adult↗
PubMed1993

Quantification of adequacy of peritoneal dialysis.

Nineteen patients treated by continuous ambulatory peritoneal dialysis (CAPD) were studied according to clinical outcome parameters: insomnia, asthenia, pruritus, arterial hypertension, anorexia, nausea and/or vomiting, anemia, and rate of hospitalization. Using clinical scores, three groups were defined: poor clinical outcome (P), intermediate (I), and good (G). The quantity of treatment by PD was evaluated monthly with urea kinetic tests (weekly Kt/V, weekly urea clearance/1.73 m2 of body surface area (BSA), index of dialysis by Teehan), and with the weekly creatinine clearance/1.73 m2 of BSA. The metabolic index was analyzed: normalized protein catabolic rate (NPCR), serum albumin (Alb) and prealbumin, and reabsorption of glucose. There was good correlation between clinical scores and quantity of dialysis. The Alb was lower in group P. Group G was differentiated from group I and from group P by quantification tests and NPCR, with lower levels as follows: weekly Kt/V = 2.06, urea clearance 70 L/week/1.73 m2, index of dialysis = 0.87, and creatinine clearance = 60 L/week/1.73 m2. We conclude that the qualitative clinical approach is not sufficient to predict deleterious signs, and the quantitative approach is predictive of the good clinical outcome and good nutritional status. We think that levels proposed to now are insufficient, and we suggest the following: weekly urea clearance > 70 L, weekly Kt/V > 2, weekly creatinine clearance > 60 L, and index of dialysis > 0.85.

Adult↗
PubMedDate not supplied

Adjunctive antibiotic/anticoagulant lock therapy in the treatment of bacteremia associated with the use of a subcutaneously implanted hemodialysis access device.

To improve vascular access for hemodialysis, a new device (Dialock Hemodialysis Access System, Biolink Corporation, Middleboro, MA) has been developed. Implanted subcutaneously, the device is accessed by percutaneous puncture. Attached to the device are two catheters that are implanted into the superior vena cava or right atrium. Clinical results thus far have been promising. However, use of this device is not free from infectious complications. In the present pilot study, 25 maintenance hemodialysis patients were implanted with 26 Dialock devices. The incidence of bacteremia was 2.9/1,000 catheter days. In 14 episodes of bacteremia in 8 patients the infection was successfully treated with a combination of systemic antibiotic treatment and adjunctive antibiotic/anticoagulant lock therapy. The lock therapy entailed the instillation of both an antibiotic and an anticoagulant into the device. We believe that the antibiotic/anticoagulant lock technique is an effective, adjunctive therapeutic modality in the treatment of infections related to the use of indwelling vascular access devices.

Anti-Bacterial Agents↗