China 
Africa 
Explore chapters and articles related to this topic
Selected Case Studies
Published in Clement Kleinstreuer, Theory and Applications, 2017
Successful and efficient chronic hemodialysis requires frequent and convenient access to blood flow rates greater than those typically found in the extremities (Cimino & Brescia, 1962). Typically, synthetic (e.g., e-PTFE) arteriovenous access grafts (AVG) in a looped or straight configuration are created to induce locally elevated blood flow rates and provide a convenient vascular access site for hemodialysis (Fig. 5-36). Unfortunately, the average access life of these grafts is usually limited to 18 months (Zibari et al., 1988; Bell & Rosenthol, 1988) and their patency has not been significantly improved since the first applications in 1976 (Windus, 1993). With 440,000 cases per year in the United States alone, AVG applications are one of the most common vascular bypass operations with the looped design being the most popular configuration in the United States.
Patients’ and care partners’ perspectives on the design of a vascular connection for a mobile dialysis device
Published in IISE Transactions on Healthcare Systems Engineering, 2023
Auður Anna Jónsdóttir, Siena Firestone, Larry Kessler, Ji-Eun Kim
The development of a mobile hemodialysis device is further complicated by the fact that there are multiple types of vascular access, the method of accessing patients’ bloodstream, each with its strengths and limitations (Ethier et al., 2008; Young et al., 2002). The two types of vascular access that are widely used for hemodialysis are arteriovenous fistulas and central venous catheters (Ethier et al., 2008). A fistula is a connection that is surgically made by joining an artery that carries blood from the heart to a vein that carries blood to the heart. This connection requires the insertion of a needle before each hemodialysis treatment. The Kidney Disease Outcomes Quality Initiative suggests that a fistula should be the first choice of physicians and patients. Fistulas pose the lowest risk of morbidity and mortality; they are also inexpensive, have low rates of complications, and are generally reliable (Churchill et al., 1992; Ethier et al., 2008; Kherlakian et al., 1986; Lok et al., 2006; Manns et al., 2005). However, fistulas are limited in use for home hemodialysis systems because the act of self-inserting a needle into the fistula is often unpleasant, painful, and traumatizing to patients (Ward et al., 2018). Moreover, fistulas’ high rates of maturation failure, or the failure to be inserted by two needles on a routine basis, often require surgical intervention (Dixon, 2006; Thamer et al., 2018; Xue et al., 2010). Such limitations of fistulas suggest the importance of a needleless method of vascular access for mobile dialysis devices.