In 14 patients over the past three years, "bypass" cannulae have been inserted to relieve obstruction in cannulae used for chronic hemodialyses. Experience with these patients has prompted changes resulting in improved technique.Clotting was the major cause of cannulae failure and infection was the second most important cause. Other causes of failure included: venous atheroma, cannulae extrusion, aneurysms of the vessel at the cannulae tips, obstructive vegetation on the vessel wall, calcium deposits on the vessel wall, and thrombi on the vein walls.The mean survival time was improved from 1.9 months in 1963-1964 to over 9.0 months in 1965-1966. The longest surviving cannula set was two years and the shortest one week.It is considered that the most important factors contributing to increased cannula survival are improved cannula care by patients and staff, the use of angiography for accurate diagnosis, and prompt anticoagulation if atheromatous stenosis of the venous component is encountered.

Adult↗

PubMed1966

Ethchlorvynol (Placidyl) intoxication and its treatment by hemodialysis.

Twenty hours after ingesting 15-25 g. of ethchlorvynol, a 37-year-old woman was admitted comatose and in shock. The blood level of ethchlorvynol was 21.6 mg. % (method of Wallace). Supportive measures were instituted and hemodialysis, carried out for 10 hours, removed 5.49 g. of the drug. The post-dialysis blood level was 9.05 mg. % and the rate of dialysance was 50.5 ml./min. Only 0.6 g. of the substance was recovered from the urine over the same period.Although dialysis removed significant amounts of the drug and sustained life, the patient remained comatose for five days before withdrawal symptoms and seizures developed.

Adult↗

PubMed1966

Chronic hemodialysis for terminal renal failure.

Ten terminal uremic patients seen over the period of one and one-half years have been kept alive by repeated hemodialysis using a modification of the Seattle system, carried out for the most part by nurses and technicians. All the patients had creatinine clearance values below 5 ml./min., and blood urea nitrogen values which ranged between 156 and 453 mg. % before beginning the first dialysis.Selection was based on their ability to co-operate with and to tolerate the regimen. Nine patients were fully rehabilitated.The major complications were those related to shunt-site infections, including septicemia, bacterial endocarditis, septic arthritis, septic pulmonary embolism and mycotic aneurysm.Nevertheless, all patients except one were rehabilitated and resumed their full-time occupations and have continued to lead happy and useful lives.

Adult↗

PubMed1966