Difficulty in accessing a new arteriovenous fistula (AVF) is a common technical issue in hemodialysis patients, which often leads to interventional radiology and/or vascular surgery referral. As a consequence, the patient who needs dialysis may require a temporary dialysis catheter with its known potential complications. We present a case where bedside ultrasonography facilitated successful cannulation of a difficult AVF. Ultrasonography (US) training in this procedure may allow early cannulation of new AVFs when the venous diameter is large enough (>0.6 cm) but the fistula is too deep (>0.6 cm). Real-time, US-guided AVF cannulation may also decrease the number of failed venous punctures per hemodialysis (HD) session minimizing vessel wall damage and subsequent potential hematoma and aneurysm formation.
Pediculosis is a common condition caused by an infestation of head and body louse (ectoparasites) and remains a public health concern. Generally, infestation presents as pruritus in children and has a benign course, but there have been a handful of cases reported in the literature describing severe iron deficiency anemia (IDA) in high-risk groups such as children, history of psychiatric disorder including depression, and low socioeconomic status. Though an uncommonly encountered etiology of anemia, the aim of this case is to increase awareness of a rare cause of severe anemia from an ectoparasites affecting a high risk population, even in developed countries.
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