Dialysis complications: Difference between revisions

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)
- 1st gen cephalosporin or vancomycin (if pen allergic)

Source

Tintinalli

Authors:

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 ==Vascular Access Complications==
 {{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==