scholarly journals Pulmonary Embolization with Tunneled Hemodialysis Catheter-Associated Blood Stream Infection: The Perils of Systemic Anticoagulation

2012 ◽  
Vol 4 (2) ◽  
pp. 73-75 ◽  
Author(s):  
Kamel A. Gharaibeh ◽  
Éva Csongrádi ◽  
Michael Shoemaker-Moyle ◽  
Anna Lerant ◽  
Mihály Tapolyai ◽  
...  
Keyword(s):  
Intracranial Hemorrhage ◽  
Blood Stream Infection ◽  
Renal Dialysis ◽  
Blood Stream ◽  
Hemodialysis Catheter ◽  
Individualized Care ◽  
Pulmonary Embolization ◽  
Systemic Anticoagulation ◽  
Stage Renal Disease ◽  
End Stage

A 35-year old African-American male with end-stage renal disease on hemodialysis through a tunneled dialysis catheter (TDC) presented with fever, diffuse aches and generalized distress. Blood cultures (BC) were obtained and empirical broad-spectrum antibiotic therapy started. After urgent renal dialysis, TDC was pulled at the bedside. Chest computed tomography (CT) diagnosed pulmonary embolism and systemic i.v. heparin was initiated. BC grew Gram positive cocci (methicillin-sensitive S. aureus) and cardiac echocardiogram confirmed acute bacterial endocarditis. Due to declined mental status, CT imaging was obtained revealing massive intracranial hemorrhage leading to the patient's death. Further chest CT review revealed only hemodynamically non-significant pulmonary emboli in some segmental and subsegmental arteries. Pulmonary embolization may be an expected occurrence with removal of infected TDC; systemic anticoagulation may not be warranted in such cases and may lead to catastrophic intracranial hemorrhage. This case draws our attention to the perils of rigid adherence to protocol and the failure of considering the needs of special patient cohorts and individualized care.

scholarly journals Colistin Induced Neurotoxicity in a Patient with End Stage Kidney Disease and Recovery with Conventional Hemodialysis

2015 ◽  
Vol 8 (1) ◽  
pp. 53-55 ◽  
Author(s):  
Radhika Chemmangattu Radhakrishnan ◽  
Shibu Jacob ◽  
Harish Ratnakarrao Pathak ◽  
Veerasami Tamilarasi
Keyword(s):  
Bacterial Infections ◽  
Blood Stream Infection ◽  
Signs And Symptoms ◽  
Blood Stream ◽  
Multidrug Resistant ◽  
End Stage Kidney Disease ◽  
Neurotoxic Effects ◽  
Stage Renal Disease ◽  
End Stage ◽  
Conventional Hemodialysis

Colistin is widely used in the treatment of multidrug resistant bacterial infections. Nephrotoxicity and neurotoxicity are risks associated with colistin use. We report the case of a 50 year old lady with end stage renal disease, treated with colistin for catheter related blood stream infection and developed muscle weakness and parasthesia. Concomitant use of meropenem may have precipitated neurotoxicity of colistin. Conventional hemodialysis was effective in reversing her signs and symptoms. Clinicians should be aware of the risk of neurotoxicity while using colistin, especially after a loading dose in patients with renal impairment. According to our knowledge, this is the first report of conventional hemodialysis reversing the neurotoxic effects of colistin.

scholarly journals Intracardiac fistula: an unusual complication of catheter-related blood stream infection

JRSM Open ◽  
2017 ◽  
Vol 8 (9) ◽  
pp. 205427041772823 ◽  
Author(s):  
Abhilash Koratala ◽  
Hussain Aboud ◽  
Robert Gibson ◽  
Karen K Hamilton
Keyword(s):  
End Stage Renal Disease ◽  
Blood Stream Infection ◽  
Significant Risk ◽  
Blood Stream ◽  
Unusual Complication ◽  
Early Use ◽  
Venous Fistula ◽  
Stage Renal Disease ◽  
End Stage ◽  
High Index Of Suspicion

Lesson In end stage renal disease patients on dialysis, the use of catheter as a vascular access is associated with a significant risk of sepsis compared to an arterio-venous fistula. Our case emphasizes the importance of having high index of suspicion for unusual complications in patients presenting with possible catheter-related blood stream infection and early use of complementary tools such as trans-oesophageal echocardiography whenever applicable.

scholarly journals Catheter-related blood stream infection in hemodialysis patients with symmetric tunneled non-side-hole hemodialysis catheters

2021 ◽  
pp. 112972982110270
Author(s):  
Michael G Tal ◽  
Alexander S Yevzlin
Keyword(s):  
Bloodstream Infection ◽  
Blood Stream Infection ◽  
Bloodstream Infections ◽  
Blood Stream ◽  
Hemodialysis Patients ◽  
Side Hole ◽  
Hemodialysis Catheter ◽  
Catheter Tip ◽  
Stage Renal Disease ◽  
Catheter Related Bloodstream Infection

Background: Tunneled hemodialysis catheter-related bloodstream infection is a major cause of morbidity and mortality in end-stage renal disease patients. Side holes positioned near the tip of catheters have been linked to formation of thrombi, which, in turn, have been implicated in predisposition to infection. In addition, side holes allow spillage of catheter locking solution, including antibiotics, thereby minimizing the lock solution’s effect on the catheter tip. This study assessed the infection events that occurred in a series of hemodialysis patients using a non-side-hole catheter. Methods: Over a period of 2 years, a novel symmetric-tip non-side-hole catheter was placed in 60 patients. Hemodialysis was performed thrice weekly. Prescribed dialyzer flows were 300–350 mL/min. Catheters were routinely locked with heparin 5000 units/mL between treatments. Patients were followed up for any catheter related complications, specifically infection events. Results: Seven events of catheter-related bloodstream infection occurred for a rate of 0.76 events per 1000 catheter-days, with the first event occurring 9 weeks after insertion. These events were treated by locking the affected catheter with 2 g of clindamycin in 2 mL of heparin 1000 units/mL and administration of intravenous antibiotics, in most cases, for 7–14 days. Two catheters were removed due to infection. Conclusions: Catheter-related bloodstream infections with non-side-hole hemodialysis catheters do occur at a relatively low rate and in this initial preliminary study it seems that most of these infections can be successfully treated without removal of the affected catheters.

scholarly journals Recurrent thrombosis of an arteriovenous fistula as a complication of COVID-19 in a chronic hemodialysis patient: A case report

2021 ◽  
pp. 112972982110008
Author(s):  
Joao Pedro Teixeira ◽  
Sara A Combs ◽  
Jonathan G Owen
Keyword(s):  
Arteriovenous Fistula ◽  
Hemodialysis Patient ◽  
Blood Stream Infection ◽  
Blood Stream ◽  
Chronic Hemodialysis ◽  
Risk Of Death ◽  
Catheter Directed Thrombolysis ◽  
Intravenous Heparin ◽  
Increased Risk ◽  
End Stage

Patients with end-stage kidney disease are at increased risk of death from coronavirus disease 2019 (COVID-19). In addition, severe COVID-19 has been associated with an increased risk of arterial and venous thromboses. In this report, we describe the case of a hemodialysis patient who developed an otherwise-unexplained thrombosis of an arteriovenous fistula during a symptomatic COVID-19 infection. Despite prompt treatment with three technically successful thrombectomies along with systemic intravenous heparin and two rounds of catheter-directed thrombolysis with tissue plasminogen activator, the fistula rapidly re-thrombosed each time and he required tunneled dialysis catheter placement. He subsequently required admission for hypoxemia from COVID-19 pneumonia and ultimately developed a catheter-related blood stream infection that likely contributed to his death. As the fistula had been previously well functioning and no angiographic explanation for the thrombosis was found, we speculate in this case the recurrent thromboses were related to the hypercoagulable state characteristic of severe COVID-19. Interventionalists performing hemodialysis access procedures should be aware of the prothrombotic state associated with COVID-19 and should consider it when deliberating how to best plan and approach access interventions in patients with symptomatic COVID-19.

Value of Ultrasound Guidance in Placement of Hemodialysis Access Catheters in Patients with End-Stage Renal Disease

2008 ◽  
Vol 74 (11) ◽  
pp. 1111-1113
Author(s):  
Chandra Hassan ◽  
H.T. Girishkumar ◽  
Bala Thatigotla ◽  
Muhammad Asad ◽  
Mahalingam Sivakumar ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Jugular Vein ◽  
Venous Occlusion ◽  
Central Vein ◽  
Ultrasound Guided ◽  
Hemodialysis Catheter ◽  
Ultrasound Assessment ◽  
Stage Renal Disease ◽  
End Stage

The increasingly frequent use of ultrasound for the placement of central venous catheters has shown improved results. This study examined the role of ultrasound in the placement of hemodialysis access catheters in patients with end-stage renal disease. The subjects were all end-stage renal disease patients admitted to our hospital between January 2004 and April 2005 and who underwent ultrasound-guided placement of a hemodialysis catheter in a central vein. All patients underwent perioperative ultrasound assessment of the venous access site, followed by fluoroscopic confirmation of the catheter placement. Data from medical charts and the hospital computer system were subjected to statistical analysis. A total of 126 patients underwent ultrasound-guided placement of a hemodialysis catheter in a central vein; 58 had undergone prior placement of a central vein catheter, but 69 had not. Patients in the later group had a 100 per cent success rate in catheter placement after ultrasound assessment of one central vein. Among patients who had previously undergone central vein catheterization, 29 had jugular venous occlusion, 12 had bilateral jugular venous occlusion and thus required placement of femoral venous catheters and, 15 patients had jugular vein stenosis and 2 patients had the jugular vein thrombosed. The use of ultrasound to assess the central veins facilitated the identification of vein suitable for catheterization and the avoidance of occluded central veins. This protocol is effective and improves patient safety.

scholarly journals Cardiac Arrest Secondary to Bilateral Pulmonary Emboli following Arteriovenous Fistula Thrombectomy: A Case Report with Review of the Literature

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Avni Shah ◽  
Naheed Ansari ◽  
Zaher Hamadeh
Keyword(s):  
Cardiac Arrest ◽  
Arteriovenous Fistula ◽  
Pulmonary Emboli ◽  
Hemodialysis Access ◽  
Number Of Patients ◽  
Life Threatening ◽  
Timely Fashion ◽  
Pulmonary Embolization ◽  
Stage Renal Disease ◽  
End Stage

Number of patients with End Stage Renal Disease (ESRD) is growing worldwide. Hemodialysis remains the main modality of renal replacement therapy for ESRD patients. A patent hemodialysis access (arteriovenous fistula or arteriovenous graft) plays a key role in successful delivery of hemodialysis. Common vascular access issues encountered by patients and nephrologists are thrombosis and infection. The thrombosed access is declotted by various percutaneous techniques these days by multiple outpatient access centers in a timely fashion. Thrombolysis can give rise to various complications, a few of which can be life threatening. A young hemodialysis patient underwent percutaneous thrombolysis of his clotted arteriovenous fistula. Outpatient access thrombectomy was complicated immediately afterwards with cardiac arrest requiring cardiac resuscitation in the recovery room. The patient was admitted to intensive care unit after life sustaining care. Work up revealed multiple pulmonary emboli to both lung fields on CT scan of the chest. Patient was anticoagulated and discharged from the hospital. Thrombolysis of clotted hemodialysis access is associated commonly with occurrences of pulmonary embolic which are usually asymptomatic. Massive pulmonary embolization due to access thrombolysis is rare. Nephrologists and radiologists should be aware of this dangerous complication particularly in patients with preexisting cardiopulmonary disease.

Calcific Uremic Arteriolopathy

2013 ◽  
Vol 24 (3) ◽  
pp. 285-300
Author(s):  
Kimberly G. Anderson
Keyword(s):  
Early Recognition ◽  
Renal Dialysis ◽  
Optimal Level ◽  
Health Care Team ◽  
Team Approach ◽  
Clear Understanding ◽  
Treatment Plans ◽  
Calcific Uremic Arteriolopathy ◽  
Stage Renal Disease ◽  
End Stage

Calcific uremic arteriolopathy is a little understood diagnosis of increasing prevalence seen predominantly in patients with chronic kidney disease, particularly those who are approaching end-stage renal disease, who are undergoing renal dialysis, and who have secondary hyperparathyroidism. Calcific uremic arteriolopathy affects women more frequently than men, at a ratio of 3:1, and the median age at diagnosis is 48 years. A clear understanding of the pathogenesis and definitive plans of care are lacking. Nurses should be familiar with the clinical picture of calcific uremic arteriolopathy. Early recognition is important to develop optimal treatment plans and to limit progression of this rare but often fatal disease. Nurses have a pivotal role in maintaining the patient’s comfort and dignity, while setting realistic goals of care. Calcific uremic arteriolopathy remains a rare and complex clinical condition that requires a multidisciplinary health care team approach to provide the optimal level of care. Nurses have an essential role in the care of patients with the diagnosis of calcific uremic arteriolopathy.

scholarly journals Hemodialysis Catheter-Related Infection in a Teaching Hospital of Central Nepal

2019 ◽  
Vol 41 (2) ◽  
pp. 11-16
Author(s):  
Arun Sedhain ◽  
Abja Sapkota ◽  
Narayan B Mahotra
Keyword(s):  
Risk Factors ◽  
Blood Stream Infection ◽  
Antibiotic Sensitivity ◽  
Major Complication ◽  
Venous Catheter ◽  
Blood Stream ◽  
Recent Change ◽  
Catheter Related Infection ◽  
Hemodialysis Catheter ◽  
A Prospective Study

Introduction: Infection of the central venous catheter (CVC) is a major complication seen among patients undergoing hemodialysis. Identifying CVC related infection (CRI) and its risk factors and causative organisms is important for better implementation of preventive strategies. Methods: A prospective study was conducted at Chitwan Medical College for duration of 2 years from January 2017to December 2018 among the patients undergoing hemodialysis via CVC. The data collected were related to patients’ demographics, site of catheter insertion, and duration, microbiological data including cultures from catheter sites, blood, and catheters’ tips and antibiotic sensitivity. Catheter related infection was divided into catheter related local infection (CRLI) and catheter related blood stream infection (CRBSI). Data was analyzed using IBM SPSS Statistics version 21.0. Results: A total of 41 cases of CVC related infection (CRI) were documented with an incidence rate of 6.94 episodes per 1000 catheter days at risk. Out of the total CRI, 39.02% were CRLI and 60.98% were CRBSI. Fever with chills and rigor were the most common clinical presentation. Risk factors for the development of CRI were duration of catheter in situ, repeated change of CVC and the use of CVC for indications other than hemodialysis (HD).Staphylococci and Klebsiella were the most common organisms isolated in culture. Conclusion: The rate of CRI among Nepalese patients undergoing hemodialysis is high. Prolonged duration of CVC usage, recent change of catheter and the use of the HD catheter for the purpose of institution of intravenous medication have been found as the risk factors for CRI.

scholarly journals P1347A DYNAMIC ULTRASOUND-IMAGING-BASED GUIDED TECHNIQUE TO TUNNELED DIALYSIS CATHETER BY MICROBUBBLES

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Erica Melo ◽  
Marcelo Silveira ◽  
Sérgio Souza ◽  
Ana Baptista ◽  
Filipe Miranda ◽  
...  
Keyword(s):  
Ultrasound Imaging ◽  
Guide Wire ◽  
Accurate Method ◽  
Primary Patency ◽  
Hemodialysis Catheter ◽  
Catheter Malfunction ◽  
Dynamic Ultrasound ◽  
The Right ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background and Aims In patients with end-stage renal disease (ESRD), the use of cuffed, tunneled dialysis catheters (TDCs) for hemodialysis has become integral to treatment plans. Fluoroscopy is a widely accepted method for the insertion and positioning of cuffed dialysis catheters, because it is easy to use, accurate and reliable, and has a relatively low incidence of complications. The purpose of our study was to evaluate the feasibility of tunneled hemodialysis catheter placement without the use of fluoroscopy but with a dynamic ultrasound-imaging-based guided technique. Method From January 2015 to December 2017, we performed an observational prospective cohort study of 56 patients with ERDS who required TDC placement. Results The overall success rate for ultrasound-guided central access was 100%, with a mean number of 1.16 (± 0.4) attempts per patient. There were no incidences of guide wire coiling/kinking, carotid puncture, pneumothorax, or catheter malfunction. Catheter flow during dialysis was 286 (± 38) ml/min. The total number of catheter days was 7,451, with a mean of 133 days and a range of 46 to 322 days. Life table analysis revealed primary patency rates of 100%, 96%, and 53% at 30, 60, and 120 days, respectively. Conclusion Dynamic ultrasound-based visualization of microbubbles in the right atrium is a highly accurate method to detect percutaneous implantation of large-lumen, tunneled, central venous catheters without the need for fluoroscopic guidance technology.

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