Very cool project: The Nephrology Oral History Project. On their homepage you can access interviews with 14 different nephrologists who practiced during the early days of dialysis, as early as the 1950s and 1960s. It’s well-organized in that each interview is broken down into labeled snippets, so you can only listen to the topics that interest you the most.
One of the more fascinating topics in these interviews is reading about how much tinkering and troubleshooting was necessary during the early days of dialysis. Access was a major issue; early on, one would cut down to find an artery and a vein in order to perform dialysis; at the end of the dialysis procedure, the vessels were ligated off and therefore those vessels could not be used again. Needless to say, there are only a limited number of arteries available to suppor dialysis, so other techniques were essential. One nephrologist describes making “home-made” catheters simply by cutting the appropriate length of polyethylene tubing and tapering off the end by holding it over a Bunsen burner. Because they couldn’t afford real stainless-steel guidewires, they used guitar strings coated in silicone, which were much cheaper.
So: the next time you grab a catheter kit off the shelf and plug in the ultrasound machine, think about all the additional hassle involved in placing a dialysis catheter our nephrology fellow predecessors had to endure!
Hi…im a PGY2 in IM. been reading ur blog regularly.very interesting.since u mentioned abt access…I have a little question!.In pts started on acute dialysis ..does the catheter tip need to be in SVC or in right atrium? are there any good evidence for this?