Difference between revisions of "Dialysis complications"

(Vascular Access Complications)
(Vascular Access Complications)
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==Vascular Access Complications==
==Vascular Access Complications==
{{AV shunt complications DDX}}
{{AV shunt complications DDX}}
*[[Clotting of AV fistula]]
===[[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
**Aneursym (true)
***Most are asymptomatic; rarely rupture
***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 from AV fistula]]===
*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==
==Peritoneal Dialysis Complications==

Revision as of 06:12, 12 December 2014

Differential Diagnosis

Dialysis Complications

Vascular Access Complications

AV Fistula Complications

Peritoneal Dialysis Complications



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


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


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