I understand the Vasca Lifesite has been cleared by the FDA for sale in the US. My Medical Director asked me if I knew anything about it and I had to admit I don't know much. I told him I would consult my favorite dialysis website, Renalweb.

This Lifesite sure seems like a good idea. As I understand it, it is a port, kind of like a chemo port, but bigger. You put two of them in a patient and they are accessed using fistula needles. I saw it at the ANNA this past spring, but at that time it was not approved for use yet so I didn't pay as much attention as I should have.

Can anyone share their Lifesite experience with me ? I assume the catheters are placed in the internal jugular. What kinds of blood flows can they get ? How about infection rate ? Or clotting ?

We have lots of patients that are on their last access and if this access is as good as they say it may be an answer to a prayer for them.

I dont know much about it. But I have been reading it on the Vasca web site....http://www.lifesite.com/homepage.htm

quote:

Originally posted by ShariB:
I dont know much about it. But I have been reading it on the Vasca web site....http://www.lifesite.com/homepage.htm

MY FRIEND, JENNIFER, JUST JOINED THE COMPANY WHO MANUFACTURES THE VASCA PORT. SALES REPS SHOULD BE AVAILABLE TO ANSWER ANY QUESTIONS YOUR MD MAY HAVE. I UNDERSTAND THAT CURRENTLY VASCULAR ACCESS SURGEONS ARE BEING CONTACTED BY REPS, BUT I AM SURE IF YOU REQUESTED INFO AND A VISIT, IT WOULD NOT BE A PROBLEM

I know I can call in the sales rep, I want to hear the clinical experience of real patients and staff in the real dialysis world. Not a nice sales pitch that conveniently leaves out any potential problems that may exist.

Anyone using this access currently ? have you used it in the past ? I want to hear it all. Good news as well as bad. Who does it work for ? Who doesn't it work for ?

quote:

Originally posted by Lydia RN:
I know I can call in the sales rep, I want to hear the clinical experience of real patients and staff in the real dialysis world. Not a nice sales pitch that conveniently leaves out any potential problems that may exist.

Anyone using this access currently ? have you used it in the past ? I want to hear it all. Good news as well as bad. Who does it work for ? Who doesn't it work for ?

WELL, YOU'RE GOING TO HAVE TO STICK WITH THE SALES PITCH SINCE THEY JUST RECEIVED FDA APPROVAL AND NO ONE IS USING THEM YET. TRY AN IV NURSE WHO UTILIZES PORTS. THEY ARE THEY SAME CONCEPT, WHICH BY THE WAY, PORTS ARE NICE! MUCH LOWER RATE OF INFECTION WITH PORTS VS CONVENTIONAL IV CATHS, YES I AM AN IV RN AS WELL.

They had to have done clinicals here in the US to get approval from the FDA. It's been for sale in Europe and Canada according to their press release. Any news from the US clincal trials or from our European friends ?

OK. The Vasca LifeSite has been out there for awhile now. Can someone please let me know what your experiences have been ?

Is it as easy to use as they say ?
Does it take more, less or about the same amount of time to get the patients on and off ?
What's the infection rate ?
Are the blood flows better than with a good fistula ?
Do your patients feel better, worse or about the same ?
How do you handle patients that travel to other units ?
In the event of a cardiac arrest, how does one defibrillate a patient with these steel devices in their chest ?

I am sorry if I appear to be a bit skeptical, but I don't want to jump into something my staff and my patients will have difficulty with. I have a good staff and they have been with me for a long time. Part of the reason thay stay is because my Medical Director and I are conservative and respect the wishes of his staff and patients.

If this is a good thing I want to know, but if it's just another flash in the pan I don't want to get involved.

I contacted Vasca directly to get information. I also talked to my surgeoun about it. Vasca was no help at all. They referred me to a rep who never returned my calls. I didn't get any information out of them. My surgeoun told me that nobody in our area (Arlington, TX) is using the LifeSte because it is too expensive and most insurances will not pay for it.

Lydia--
I have used a LOT of them. It's a great idea on paper but still has kinks that need to be worked out BIG TIME. We have seen at least 5 deaths over the past year from sepsis related to pocket infections. One death from tamponade post placement. Several med device reports on the FDA web page reflecting similar experiences. The doc who invented it is a brilliant man and the device has potential--it just requires STRICT prep prior to cannulation and I'm not sure that can be obtained in the average HD unit.

We have used the LifeSytes with a few patients at the unit I work in. There are advantages and disadvantages. We have only used them in patients as a last access attempt. The BFR we have acheived have been usually between 300-400. One of our patients had had problems with them clotting and requiring TPA infusions or dwelling. Initially cannulation is painful untill the tract is well established. Cannulating them can be tricky also. One patients pocket became infected despite the alcohol irrigations. With the infections the port moved and new tunnels had to be established. Eventually the port had to be removed and a new port inserted. It is critical that the needles go in absolutely straight up and down. If the port moves and the same tunnel is used the needle sits at an angle and can leak blood back out into the pocket. Cannulation does require additional different skills. It is difficult to feel for exactly right placement through all of the swelling the first several times. Defibrillations is no different then if someone has a pacemaker. Try not to put the paddle directly on the port and hope for the best. I hope this helps or if I can answer any more questions

What is the longest time a patient has had the lifesite access? Have you had anymore infections? Do you think they lock secure enough to be used in a slow nocturnal program? Are you still hopeing for the best or do you feel more confident in accessing them now?

I've stuck the LifeSite approx. 4 times so far. My company has had two patients with Lifesite so far. One got infected and had to be removed. The other just got hers. So far it's doing ok. It takes more time and materials to get the pt. hooked up and to take the pt. off. I'd only recommend it as a "last resort" alternative at present.
If you want to further this discussion, my email is
mimccown@hotmail.com

quote:

Originally posted by Lydia RN:
I know I can call in the sales rep, I want to hear the clinical experience of real patients and staff in the real dialysis world. Not a nice sales pitch that conveniently leaves out any potential problems that may exist.

Anyone using this access currently ? have you used it in the past ? I want to hear it all. Good news as well as bad. Who does it work for ? Who doesn't it work for ?

Hello Lydia,
Our unit has one patient who received the LifeSite catheter because of numerous clotting problems with her graft. So far, the device is working well. It does take a bit longer to get everything ready, and the cannulation can be tricky at first. She's only had the device for two weeks, so obviously it's way too early to tell what problems, if any, we're going to run in to. She tolerated the cannulation without the use of lidocaine right after the device was inserted, and two weeks later, she still doesn't require lidocaine. We have been getting blood flows of 400 without any trouble. The patient does complain of soreness around the insertion site but it has steadily decreased since the surgery. At the present time, only RN's can do the cannulation and disconnect, so that may be a factor if your unit doesn't have a lot of RN's to go around. My entire staff watched the instructional video so they are all aware of the put-on and take-off procedure, and what supplies are needed. The only concern that I have right now is that tPa is required to declot the device, and that is quite an expensive drug to have on hand.
I hopes this helps a little, even tho' we've only had experience with this for two weeks.

Our staff RN's have not been impressed with the LIFESITE. I must say the VASCA reps have been very attentive, and have inservice everyone, and have been there for the cannulations. One pt. got an infection immediately, the lifesites were removed. Another pt. has one left of 2. We are not impressed. When the lifesite clotted. She was hospitalized on Friday, came back to the unit in 6 days. They cannot travel. We have a very experienced staff - it is not a unit problem. I suggest you find the opinion of other facilities who are actually using it, before you encourage your nephrologists to push for this access. Some HMO's do not pay for it, because it is new.

Lydia,
I do agree with the reply from "not happy" in regard to patients being able to travel. Our one patient with the Lifesite wanted to visit her daughter during Thanksgiving but the unit she would have visited has never heard of the Lifesite, so obviously would not have the supplies or staff to access it. Something to think about if you have patients who travel frequently.