Experience with Vascular Access for Acute Renal Failure: Using Buselmeier Shunt and Femoral Vessel Catheter

Abstract

Three types of vascular access were evaluated over a period of 2 years, January 1987-December 1989, in 76 critically ill acute renal failure (ARF) patients. The Buselmeier shunt comprised 75% of the acute vascular access which were utilized, the cannulation of the femoral vessel 23% and the Scribner shunt 2%. The Buselmeier shunt was successfully used alone (mainly in the forearm) in 58 patients for continuous arteriovenous hemofiltration, continuous arteriovenous hemodialysis and intermittent hemofiltration. Thrombosis was noted in 7% of the shunts, where the majority needed a new shunt either on the same or the contralateral arm. Blood leakage was noted in 2%, hematoma in 1%, and accidental bleeding in 1% of the shunts. This study showed that the Buselmeier shunt is more used in our center, most likely because it is easy to bypass the hemodialysis filter by the staff nurse in case of clotting. No major complications were noted even if kept in place for a longer period of time. It offers adequate blood flow for continuous renal replacement therapy and intermittent hemofiltration in ARF.

Vascular Access for Continuous Renal Replacement Therapy

“…Their main limitation is the relatively low blood flows, especially when inadequate vessels allow only the entry of small gauge vessel tips. Alarabi et al have reported on the successful use of Buselmeier shunts (24). These have arterial and venous side-arms arising from the main shunt loop.…”

Continuous Arteriovenous Hemodialysis: Outcome in Intensive Care Acute Renal Failure Patients

“…Usually, a Buselmeier shunt was preferred because, from our experience, it is reliable, gives adequate blood flow and is easy to bypass if there is clotting [5]. An alternative method o f cannulation of the femoral vessels by femoral catheters is the Mahurkar (Quinton Instrument, Seattle.…”