Difference between revisions of "Dialysis complications"

(Thrombosis and Stenosis)
(Vascular Access Complications)
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==Vascular Access Complications==
 
==Vascular Access Complications==
===Thrombosis and Stenosis===
+
{{AV shunt complications DDX}}
[[Clotting of AV fistula]]
+
*[[Clotting of AV fistula]]
  
===Infection===
+
===[[Infection of AV fistula]]===
 
*Pts often p/w signs of systemic [[sepsis]] ([[fever]], [[hypotension]], leukocytosis)
 
*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
 
**Classic signs of pain, erythema, swelling, d/c from infected access are often missing
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***Even so catheter is only removed if fever persists for 2-3d after abx are started
 
***Even so catheter is only removed if fever persists for 2-3d after abx are started
  
===Hemorrhage===
+
===[[Hemorrhage of AV fistula]]===
 
*Potentially life-threatening
 
*Potentially life-threatening
 
*Can result from aneurysms, anastomosis rupture, or over-anticoagulation
 
*Can result from aneurysms, anastomosis rupture, or over-anticoagulation
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**Exercise pain, nonhealing ulcers, cool, pulseless digits
 
**Exercise pain, nonhealing ulcers, cool, pulseless digits
 
**Diagnosed by Doppler US or angiography, repaired surgically
 
**Diagnosed by Doppler US or angiography, repaired surgically
===High-output heart failure===
+
 
 +
===[[High-output heart failure from AV fistula]]===
 
*Occurs when >20% of cardiac output is diverted through the access
 
*Occurs when >20% of cardiac output is diverted through the access
 
**Branham sign (drop in HR after temporary access occlusion) is diagnostic
 
**Branham sign (drop in HR after temporary access occlusion) is diagnostic

Revision as of 06:07, 12 December 2014

Differential Diagnosis

Dialysis Complications

Vascular Access Complications

AV Fistula Complications

Infection of AV fistula

  • 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 of AV fistula

  • 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 from AV fistula

  • 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