The Scribner shunt: 50 years later

Joseph B Lockridge¹ and Sindhu Chandran²

1. ¹Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
2. ²Division of Nephrology, Kidney Transplant Unit, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
3. 
   
4. http://www.nature.com/ki/journal/v81/n1/full/ki2011344a.html

A 49-year-old male with end-stage renal disease returned to the United States 6 months following a repeat renal transplant in the Philippines that had failed 1 month after surgery. He presented with no records of his surgery or hospitalization, and stated that he had been on hemodialysis for 5 months. A Scribner shunt in the left arm (Figure 1) was identified by the nephrology service about 24 h following admission, with the connecting segment visible about 0.5 cm between the shunt lines (Figure 2). The arm was immediately covered with a dressing to minimize the risk of avulsion or interruption of the tubing, arterial clamps were made available at the bedside, and the device was removed 3 days later by a vascular surgeon. The ‘simplified’ or ‘poor-man's’ Scribner shunt (as it was known in the United Kingdom because it was inserted by the renal senior house officer rather than the surgeon) was developed in 1964 and consists of a simple loop of Teflon, which connects indwelling cannulae in the artery and vein. The connecting segment allows the artery and vein extensions to be attached to the dialyzer during dialysis and to be re-connected to each other after the treatment is completed. These shunts were prone to thrombosis, infection, and dislodgement and disappeared from most countries in the late 1970s and early 1980s, as venous catheters became widely adopted for temporary hemodialysis access. Many younger nephrologists in the United States have never seen a Scribner shunt. Prompt visual recognition is essential to avoid inadvertent manipulation or cannulation of the shunt, which can result in catastrophic bleeding.