A new bone anchored hemodialysis access

Arnold, Andreas Michael; Kruse, Anja; Wiedmer, Simona; Widmer, Matthias; Guignard, Jérémie; Schütz, Daniel; Guenat, Jean-Marc; Bachtler, Matthias; Caversaccio, Marco; Uehlinger, Dominik E.; Frey, Felix J.; Häusler, Rudolf; Stieger, Christof (2015). A new bone anchored hemodialysis access. Therapeutische Umschau, 72(8), pp. 519-524. Huber 10.1024/0040-5930/a000709

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When classic arteriovenous fistulas or grafts fail, dialysis patients have a vital requirement for a catheter to ensure vascular access. Permanent central venous catheters penetrate the cervical and thoracic soft tissues and the skin without rigid fixation. The infection rate for such devices is high, often requiring explantation. Bone anchored hearing aids are an established treatment in patients with conductive hearing loss. The implant is firmly fixed on the temporal bone and the abutment permanently penetrates the skin. Severe infections requiring explantation are very rare. We suppose that one of the main reasons for the low complication rate is the firm fixation of the implant to the temporal bone, which minimizes the movement of the skin relative to the underlying bone. Based on the experience with implantable hearing devices we developed a percutaneous bone anchored port fixed to the skull in the region of the temporal bone. Such a bone anchored port could be a beneficial alternative to conventional central venous catheters for patients undergoing hemodialysis. In the course of the development process we investigated the individual anatomy to locate the correct implantation site with sufficient bone thickness; we studied screw stability in bone; we developed the titanium implant that houses the port system as well as the surgical tools and procedure for save implantation; we tested flow rate, leak tightness and purification on mockups; we defined the Seldinger-insertion of the catheter into the internal jugular vein via a small neck incision. Our results show the technical feasibility of a temporal bone anchored port and form the basis of a now-approved clinical pilot study.

Item Type:

Journal Article (Further Contribution)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Ear, Nose and Throat Disorders (ENT)
10 Strategic Research Centers > ARTORG Center for Biomedical Engineering Research > ARTORG Center - Image Guided Therapy > ARTORG Center - Artificial Hearing Research
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery
04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Nephrology and Hypertension
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > Unit Childrens Hospital > Forschungsgruppe Nephrologie / Hypertonie

UniBE Contributor:

Arnold, Andreas Michael; Widmer, Matthias; Bachtler, Matthias; Caversaccio, Marco; Uehlinger, Dominik; Häusler, Rudolf and Stieger, Christof

Subjects:

600 Technology > 610 Medicine & health
600 Technology
600 Technology > 620 Engineering

ISSN:

0040-5930

Publisher:

Huber

Language:

German

Submitter:

Dominik Uehlinger

Date Deposited:

11 Feb 2016 09:53

Last Modified:

30 May 2016 14:04

Publisher DOI:

10.1024/0040-5930/a000709

PubMed ID:

26227980

BORIS DOI:

10.7892/boris.75423

URI:

https://boris.unibe.ch/id/eprint/75423

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