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...everything you need to know about doing dialysis at home.
Here we present a chronological tour of dialysis from the beginning.
All photos by Jim Curtis; descriptions courtesy of Baxter.
Richard Stewart, MD, was given a grant to explore the medical applications of cellulose acetate capillary fibers. His group determined that this technology would have a practical application as an artificial kidney.
The original “Capillary Kidney” demonstrated that substances could be selectively removed from the blood as well as excess water.
Stewart et al developed larger versions for clinical use. They set as their criteria that the device must be as efficient as the “Twin Coil Dialyzer,” but it must have a lower priming volume and be more reliable.
The clinical model shown here was first used at the University of Michigan in Ann Arbor, MI, and later at the Marquette School of Medicine in Milwaukee, WI. The “Capillary Artificial Kidney” has become the standard for hemodialysis today.
This fully integrated dialysis delivery system was developed by Travenol Laboratories for use by hospitals and for home dialysis. The initial cost of the system was $1,400, and over 3,500 of these devices were produced and used all over the world.
The machine required that the bath be mixed each time. The reservoir contained 120 liters of water and concentrate. Many centers used ordinary tap water. The treatment time was six hours and the patient was treated from one to three times a week depending on the condition of the patient.
This type of machine utilized the coil type dialyzer and it was later modified to use the hollow fiber dialyzer. The “Travenol RSP” is the term used to describe this hemodialysis system. It means single pass recirculating hemodialysis machine.
Belding Scribner, MD, at the University of Washington in Seattle, WA, asked Wayne Quinton, a biomedical engineer, to help him develop a permanent access to the blood stream for patients who had kidney failure. Scribner was convinced that he could chronically treat a patient with kidney failure if a permanent access was available.
Quinton developed a vessel access using Teflon™ tubing. This material was successful because of its non-stick properties that prevented the blood from adhering to it and clotting.
They were able to demonstrate that a permanent access was possible and that they could chronically dialyze a kidney failure patient.
Later they would use silicone tubing for the external segment in order to act as a shock absorber and to provide more comfort and safety for the patient. This device was worn by a chronically-dialyzed kidney patient.
Quinton W, Dillard D, Scribner BH. Cannulation of blood vessels for prolonged hemodialysis. Trans Am Soc Artif Intern Organs. 1960 Apr 10-11; 6: 104-13.
This PD machine (3 bottles, 2 pumps) was made by Drake Willock. It’s identified as Model 6010. It incorporated an RO inside to make the peritoneal solution, so the 40 liter bottles were no longer needed.
The demise of this unit was the introduction of plastic bags of PD solution and CAPD by Baxter in the late 1970s.
This type of dialyzer used sheets of membrane mounted on top of plastic support screens, and stacked in layers. Dialysate would flow between some of the pairs of membranes, and blood between other pairs. The design was low-cost, and allowed for very little resistance to flow, so fewer anti-clotting medications were needed. In time, this model was entirely replaced by the hollow fiber dialyzer.
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