Difference between revisions of "Dialysis complications"

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==[[Dialysis-associated hypotension]]==
+
*[[Dialysis-associated hypotension]]
==[[Dialysis disequilibrium syndrome]]==
+
*[[Dialysis disequilibrium syndrome]]
*Diagnosis of exclusion (r/o SDH, CVA)
+
*[[Air embolism]]
*Clinical syndrome occurring at end of dialysis
 
**Occurs most commonly during initial dialysis or during hypercatabolic states
 
**Large solute clearances -> cerebral edema
 
*Symptoms
 
**N/V, HTN; can progress to seizure, coma, death
 
*Treat w/ mannitol
 
 
 
==Air Embolism==
 
*Acute dyspnea, chest tightness, LOC, cardiac arrest
 
*Treat w/ 100% NRB
 
  
 
==Vascular Access Complications==
 
==Vascular Access Complications==

Revision as of 16:22, 11 December 2014

Vascular Access Complications

Thrombosis and Stenosis

  • Most common causes of inadequate dialysis flow
    • Loss of bruit and thrill over access
  • Stenosis and even thrombosis are not emergencies
    • Can be treated w/in 24hr by angiographic clot removal or angioplasty
    • Thrombosis of vascular access can be treated w/ direct injection of alteplase 2.2mg
      • This therapy should be discussed with the vascular surgeon first

Infection

  • Pts often p/w signs of systemic sepsis (fever, hypotension, leukocytosis)
    • Classic signs of pain, erythema, swelling, d/c from infected access are often missing
  • Dialysis catheter–related bacteremia is common and potentially life-threatening
    • Give vancomycin 1gm IV +/- genamicin 100mg IV (if gram neg suspected)
    • Do not remove dialysis patient's access
  • Draw peripheral and catheter blood cultures simultaneously
    • 4x higher colony count in catheter blood cx suggests catheter is source of bacteremia
      • Even so catheter is only removed if fever persists for 2-3d after abx are started

Hemorrhage

  • Potentially life-threatening
  • Can result from aneurysms, anastomosis rupture, or over-anticoagulation
  • Control bleeding w/ pressure applied to puncture site for 5-10min; observee for 1-2hr
  • Types
    • Aneursym (true)
      • Most are asymptomatic; rarely rupture
    • Pseudoaneurysm
      • Results from subcutaneous extravasation of blood from puncture sites
      • Bleeding from puncture site is usually controlled by digital pressure or subq suture
      • Consider vascular surgery consultation for continued bleeding or infection
      • Arterial Doppler US studies can identify the aneurysm or pseudoaneurysm

Vascular insufficiency

  • Distal extremity becomes ischemic due shunting of arterial blood to venous side
    • Exercise pain, nonhealing ulcers, cool, pulseless digits
    • Diagnosed by Doppler US or angiography, repaired surgically

High-output heart failure

  • Occurs when >20% of cardiac output is diverted through the access
    • Branham sign (drop in HR after temporary access occlusion) is diagnostic
    • Doppler US can accurately measure access flow rate and establish the diagnosis
    • Tx = surgical banding of the access

Peritoneal Dialysis Complications

Peritonitis

Background

  • Most common complication
  • Presentation no different from other causes of peritonitis

Diagnosis

  • Send dialysate fluid for cell count, Gram stain, cx (if available)
    • Cell count >100 w/ >50% neutrophils most c/w infection

Treatment

  • Can add [[antibiotic] to the dialysate if possible (parenteral abx not required)

Source

Tintinalli