Seminars in dialysis
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Seminars in dialysis · Nov 2010
ReviewContinuous renal replacement therapy: cause and treatment of electrolyte complications.
Continuous renal replacement therapy (CRRT) has become the modality of choice for critically ill patients. Although often hemodynamically better tolerated than intermittent dialysis, the continuous nature of this therapy may cause significant electrolyte complications. These complications commonly result from removal of electrolytes from the body without adequate replacement or because of the use of trisodium citrate as the anticoagulant. ⋯ Although CRRT may cause electrolyte complication it also can be the treatment of choice for the correction of certain electrolyte complications. In patients with acute or chronic renal failure who present with significant dysnatremias, intermittent hemodialysis may cause overly rapid correction of the serum sodium with serious neurologic sequelae. The ability to manipulate the sodium concentration of the dialysate or replacement fluid and the more sustained nature of the treatment allows for a slower correction thus avoiding complications.
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Seminars in dialysis · Nov 2010
Comparative StudyRadiation exposure in dialysis access-related procedures decreases with increase in number of procedures performed by the interventional nephrologist.
An appreciation of the inherent risks with radiation exposure to patients and to the physician performing the procedure and the staff is urgently needed. The objective of this study is to assess radiation exposure to both patients and interventional nephrologists performing procedures and see any trends in the procedure and fluoroscopy times over a 2-year period. A total of 400 procedures performed at our vascular access center by a new to practice interventional nephrologist were recorded and retrospectively analyzed. ⋯ The mean fluoroscopy time for the last two quarters was 1 minute and 54 seconds, and the median was 1 minute and 26 seconds. The mean procedure time for the last two quarters was 27 minutes, and the median was 21 minutes. In conclusion, gain of experience by the practicing Interventional Nephrologist from performing an increasing number of procedures leads to decreased procedure times and fluoroscopy times, which lowers the risk of radiation.
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Infectious spondylodiscitis is an infection seen with increasing frequency in patients receiving chronic hemodialysis. Often accompanied by bacteremia, it is associated with the use of central venous catheters for hemodialysis access. ⋯ Therefore, the clinician must have a low threshold for diagnostic testing that goes beyond blood cultures. This, in addition to early empiric antibiotic therapy, may improve the outcome of this potentially catastrophic infection.
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Seminars in dialysis · Nov 2010
Case ReportsThe catheter-challenged patient and the need to recognize the recurrently dysfunctional tunneled dialysis catheter.
Tunneled dialysis catheters (TDC) become dysfunctional because of placement problems, infection, thrombosis, and fibrin sheath formation. Occasional patients who are catheter dependant develop frequent catheter dysfunction because of thrombosis or thrombosis associated with fibrin sheath formation. This article attempts to define which dysfunctional catheters because of thrombosis and thrombosis associated with fibrin sheath formation actually represent a recurrently dysfunctional TDC (RDC) and puts forth an approach to managing the RDC.
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Seminars in dialysis · Sep 2010
Case ReportsRetained catheter fragment from a fractured tunneled catheter--a rare and potentially lethal complication.
Despite efforts to curtail central vein catheter use for dialysis catheters are frequently used in the treatment of end-stage renal disease (ESRD). In 2006, 82% of patients in the USA initiated dialysis via a catheter. ⋯ Herein, we present the case of an incidental finding of a retained catheter fragment from a fractured TCC in the right atrium. Fragment retrieval (via snare technique) and subsequent placement of a new central venous catheter are outlined.