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Intermittent Haemodialysis-Clunie et al.BRIT was an obvious mechanical cause. If flow was still unsatisfactory after attempted declotting, clots were occasionally dislodged or vessel spasm was overcome by the slow infusion of a solution of 20,000 international units of heparin in 500 ml. of saline. Angiograms were performed by the injection of 3 to 4 ml. of 60% Urografin via the open end of the cannula (Fig. 3) in resistant cases. An attempt was then made to dissolve visualized clot by the injection of 250,000 units of streptokinase (Kabikinase) in 2 ml. of sterile water into the cannula, which was clamped for 30 minutes. Flow was restored by this procedure on four of the seven occasions on which it was used.Where declotting was not successful, one limb or occasionally both limbs of the shunt were replaced. Anticoagulants were used systemically after recurrent episodes of clotting, and were particularly valuable where there was evidence of phlebitis.Twenty episodes of infection occurred in 8 of the 11 patients, boeing secondary to skin erosion over the venous loop on seven ,occasions. Nine of these infections led to loss of cannulae. 'The causative organism was Staphylococcus aureus, except in -wo cases where a f8-haemolytic streptococcus was isolated. Septicaemia secondary to cannula infection occurred in two patients, and was successfully treated by antibiotics without loss of the cannulae. Nasal, throat, and perineal swabs were taken before insertion of cannulae and at intervals thereafter. Attempts were made to eradicate nasal and skin carriage of staphylococcus, but persistent carriers were treated with lincomycin (Lincocin), cloxacillin (Orbenin), or methicillin (Celbenin) from the time of insertion of cannulae for periods of two to four weeks. If infection became established and persisted in spite of antibiotic therapy, the cannulae were removed and another limb was cannulated next day under antibiotic cover. In four patients with infected arterial cannula wounds persistent bleeding occurred, and was found to be due to false aneurysm formation. Bleeding was controlled by proximal ligation of the vessel and removal of the cannula. A more detailed analysis of these infections, with particular reference to phage typing and the source of the organisms, will be presented elsewhere. SummaryTwo years' experience with the Silastic-Teflon arteriovenous cannula system in the management of patients with chronic renal failure by intermittent haemodialysis is reported. The mean arterial cannula survival time was 7.6 months and the venous survival time 7.3 months. Careful attention to a number of apparently minor points during insertion improved cannula survival. The two limiting factors in cannula life were clotting and infection. Declotting was usually achieved if the patient attended within three hours. If flow was unsatisfactory after using standard declotting procedures angiography was performed and streptokinase infused into the cannula. Flow was restored in four out of seven cannulae by this method. The causativ...

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Summary. Men with indwelling catheters and men and women with suprapubic catheters were studied in their homes. Urine and blood were cultured and body temperature recorded after every catheter change. Nearly all patients had infected urine after 4 weeks of catheterisation, and all had bacteriuria after longer periods, usually with a mixture of organisms. Culture on selective media revealed a wider range of organisms than was detected on routine C.L.E.D. and blood agar with antibiotic sensitivity disks, but routine culture gave adequate information for clinical purposes. Bacteraemia was demonstrated after 20 of 197 changes of urethral catheter and after one of 19 changes of suprapubic catheter; but no patient had pyrexia or other symptoms. However, two had rigors on other occasions. When assessing "risk factors" for blood-stream infection in catheterised patients, it is important to record the total incidence of bacteraemia, asymptomatic as well as symptomatic.

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