Dialysis complications

Revision as of 06:10, 12 December 2014 by Rossdonaldson1 (talk | contribs) (Vascular Access Complications)

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 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

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