Why cant they make a painless access point

[paul.karen]

in a fistula style?

Like laying a titanium pipe in place of a fistula.  With a screw on cap for an access point.
No needles no pain.  Unscrew a cap much like a toothpaste cap insert needle into the metal tube that internally connects to your arteries.  When done recap and be on your way.  Of course before and after uncapping and recapping you would have to scrub it with some type of disinfectant.

it seems this would be easy enough to do.   We have mechanical hearts-knees-hips ect ect.  Yet we cant make a permanenet yet opening and closing access point for people on dialysis?

[MandaMe1986]

If you got a line in your neck that is what it would be like. Eh, its a pain in the butt.  I had a few ports for chemo, and they sucked indeed. But I would take the needle and pain over the high risk infection any day.  Anytime you have an open line (like a cap you are talking about) you are pron to infection.  I had a line placed in my neck and I ended up getting a staff infection and wow, that was hell. Two weeks in a step down unit not knowing one day from the next.  And then another 3 months in and out of the hospital because the infection keept comming back. It was hiding somewhere in my body.  Now if they could do all that and fix the infection rate, I would love that!

[Zach]

Here you go:
http://www.freepatentsonline.com/6231541.html
http://www.patentstorm.us/patents/6231541.html

See page 9:
http://www.sfav.org/Publication/SFAV2005/P01.pdf

It led to infections.
 

[paul.karen]

Thx zach.

Those patents are going back to 2001.
Wonder if they will ever work the bugs out and make it infection proof or close to it.

[monrein]

Our own skin is the best protection there is against infection.  The old system with ports posed terrible problems for patients.   

[del]

paul.karen hubby says buttonholes are painless.  He's been using them for 2 1/2 years now.
.

[Adam_W]

I wish something like that could be perfected that would eliminate post tx bleeding! Something like a normal graft, only with arterial and venous "valves" that would open when the needle went through them to allow the blood to flow, but would "snap" closed when the needle is removed, eliminating potential excessive bleeding from the needle sites. The valves could be completely under the skin, just like a normal graft or fistula, and blunt tipped needles similar to buttonhole needles could be used. I know, I'm dreaming.

Adam

[pelagia]

paul.karen hubby says buttonholes are painless.  He's been using them for 2 1/2 years now.
.

Is a buttonhole something like a piercing in an ear?  That's how I envision it, but I know the ear is much less sensitive than the average patch of skin.

[monrein]

It does become like a pierced ear tunnel though and you wiggle the blunt in through the tunnel (after picking off the scabs with a sterile needle) then push it through the vein wall and that's it.  No pain unless you go through a nerve like I do for my venous.  When you feel the skin there are little bumps where the tunnels are.

[Rerun]

I wish it was something a little like Star Trek.... You stood on the target and it would "beam" all the toxins out of you and you would be fresh to go. 

                   

[Bill Peckham]

You could get away from needles by dividing the process into two procedures. An implantable device to control fluids - to remove only water, plumbed into the our urinary system (you'd be peeing distilled water). And then use Eli Friedman's dialysis pill to remove toxins by using the intestines as the semipermeable membrane.

There was something called the Lifesite on the market a few years ago that was a lot like what Adam described. It was in the chest and there were two ports under the skin. They caused an increase in clots/strokes which got it pulled from the market (Google: lifesite dialysis death)

What about just killing the nerves in the area of the fistula? Can nerves be switched off? When you're sticking yourself it helps to have the biofeedback to guide needle placement but once the buttonholes are established it's less important.

I wouldn't say my buttonholes are painless but the sensation is predictable - it's the same each time. I think it s the unpredictability of the cannulation pain that is a problem. Like getting a tatoo - if it is the same sensation it becomes tolerable. Have you looked into the buttonhole technique PK?

[paul.karen]

Yes i have Bill. If i were to do hemo i would likely go that route.
I am gonna start out doing PD. No fear of needles just seems easier and can free up days for work schedule.
and less restriction on foods and amounts of liquid intake.  But when i do get my pd access i also want to get a fistula as a backup.
My neph said that isnt necessary.  But i will talk to him next month and tell him to me it is necessary.  Better then the other options.
I can only afford to loose as little work as i can..

[Rerun]

Paul, I would not get a fistula now.  PD may last you for years and if the fistula is not used it may clot off.  If PD goes bad for some reason down the road they can always put in an emergency catheter in your chest which is not a big deal and at that point they will create a fistula.

Just my 

[Bill Peckham]

Paul, I would not get a fistula now.  PD may last you for years and if the fistula is not used it may clot off.  If PD goes bad for some reason down the road they can always put in an emergency catheter in your chest which is not a big deal and at that point they will create a fistula.

Just my 

I think it is a good idea to get a fistula placed. Catheters are suboptimal and starting hemodialysis with a fistula is shown by DOPPS data to provide a mortality advantage.

[paddbear0000]

The permanent access could have a self-sealing type membrane like those on vials of insulin, saline, heparin, etc. And nowadays, they can infuse all kinds of materials with anti-microbial protection. The membrane could have that.

[monrein]

The self sealing capability wears off though in time and becomes a problem. 

[paul.karen]

Padd that is kinda the method i was thinking about as well.

I would think if such a design was made that the self sealing pre antibiotical seal would/could be replacable easily.

But if it was all that easy it would have been done for now.
And bill killing the nerves is a good idea as well.  For people afraid of needles. or just people who dont like pain.  But also like you state.  And i never thought of the fact having that feedback from the sticking helps the process...

To me it just seems we have such advanced medical procedures the dialysis process being one of them.  Yet we cant make a permanent painfree access point.

[Zach]

To me it just seems we have such advanced medical procedures the dialysis process being one of them.  Yet we cant make a permanent painfree access point.

And that's why vascular access is referred to as the "Achilles' heel" of hemodialysis.