Difference between revisions of "Dialysis complications"

(Vascular Access Complications)
(Vascular Access Complications)
Line 4: Line 4:
 
==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
 
*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 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

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