Belding Scribner and his arteriovenous Teflon shunt

Belding Scribner. Photo by Kay Rodriguez. From University of Washington School of Medicine Online News Archive.

Without Belding Scribner maintenance dialysis might have never happened. Although by 1960 the technology of hemodialysis had become quite advanced, and several types of dialyzers, notably the Kolff Twin Coil, had been successfully used, long-term access to the vascular system was still not available. The choice for the physician was to cut down on peripheral vessels for each dialysis or to repeatedly cannulate the larger femoral ones with the recently developed Shaldon catheters.

It was at this critical moment that Belding Scribner invented his shunt. He describes in his memoirs how the idea came to him suddenly. Enlisting several skilled, technically minded associates, he constructed what at first was a cumbersome device. Pointed Teflon tips were to be inserted into peripheral blood vessels and joined by metal crimp rings to silastic tubing that at the end of dialysis were connected to each other by a U-shaped piece of Teflon. To stabilize the shunt and avoid it being displaced, it was supported by a metal plate attached to the forearm. It was a complex piece of engineering, but it worked and allowed for repetitive dialysis.

In time the arrangement was simplified. The Teflon tips were connected seamlessly to the silastic and the supporting plate was eliminated. As a result it was now possible to dialyze patients long term, and the Scribner shunt became widely used. It would sometimes become infected, especially in patients with poor hygiene, and often became clotted. But it remained the universally used mode of vascular access until the late 1960s, when Drs. Brescia and Cimino developed the arterio-venous fistula that made the external Scribner shunt obsolete.

 

A brief note about Dr. Scribner, whose invention made long-term hemodialysis possible:

He was born in 1921 in Illinois and spent most of his youth there. In 1945 he obtained a Bachelor of Arts degree from Berkeley, and in 1941 graduated MD from Stanford, where he was mentored by Thomas Addis. After completing an internship at the San Francisco Hospital, he became a nephrology fellow at the Mayo Clinic and there developed a bedside test for measuring electrolytes. In 1950 he was inspired by listening to a lecture by John P. Merrill on the rotating drum artificial kidney. Moving to Seattle, he became director of research first at the Veterans Administration Hospital and in 1958 at the University of Washington. There he developed a nephrology program, and one night in 1960 the idea came to him of developing an implantable permanent shunt that would allow long-term dialysis. His first patient was the famous Clyde Shields, who was maintained on dialysis for eleven years. A layered Kiil dialyzer was used, and soon Seattle became a mecca of maintenance dialysis.

Dr. Scribner, however, did not rest on his laurels. In coming years he made many contributions to the field of dialysis, notably initiating long-term peritoneal dialysis; setting up ethics committees to decide who could be dialyzed at a time when facilities were still very limited; and developing the concept of retained middle molecular products in uremia that had to be taken into consideration when planning a dialysis schedule. He worked on parenteral nutrition, kidney transplantation, dialysis adequacy, treatment of hypertension, and helped convince Congress to pass legislation to pay for dialysis. In his spare time he was a wine aficionado. He died in 2003 in a boating accident and is remembered as a pioneer who made a seminal contribution to the treatment of kidney disease by dialysis.

 

Set up of later Scribner shunt
The shunt in the arm of Clyde Shields. From “Belding Hibbard Scribner—Better Known as Scrib” by Christopher R. Blagg.

Courtesy of the Author.

 

References

  • Blagg, C.R. “Scrib”- Belding Hibbard Scribner, 1921 – 2003, in Dialysis, edited by T.S.  Ing, M.S. Rahman,and C.M. Kjellstrand. Chapter 2, p, World Scientific, Singapore, 2012
  • Scribner BH.  A personalized history of chronic hemodialysis, Am. J. Kidney Dis. 1990, 16:511 (December)
  • Lenzer J. Belding Scribner.BMJ 2003;327:167 (July 19).
  • Obituary. A tribute to Belding H. Scribner. Nephrol. Dial. Transplant 2004; 19:507 and 509.

 


 

GEORGE DUNEA, MD, Editor-in-Chief

 

Spring 2020  |  Sections  |  Nephrology & Hypertension