Introduction: Many techniques are available for inserting peritoneal dialysis (PD) or continuous ambulatory peritoneal dialysis (CAPD) catheters, with varying possible complications. We report a case of bladder perforation that was managed with catheter salvage. Case report: A 48-year-old man with end-stage renal disease (ESRD) underwent CAPD catheter placement percutaneously, with tip in the pelvis. On the 3 rd day after placement, the patient complained of increase in urinary volume with PD flushing. Urine analysis showed 3(+) glucose and absent creatinine. Cystogram showed the catheter abutting the bladder wall. CT of the abdomen showed the catheter piercing the bladder and exiting through the posterior wall. The PD catheter was repositioned under fluoroscopy. Discussion: The complications surrounding insertion of CAPD catheter can be either mechanical or infectious. Peritoneo-vesical fistula or placement of the PD catheter into the urinary bladder is a very rare complication. The possibility of catheter salvage should be entertained while discussing management options.
Atrial fibrillation (AF) is a relatively commonly encountered tachyarrhythmia, with its prevalence increasing with increase in age. AF is usually associated with an underlying cardiac disease, but transient AF has also been reported from mechanical stretch and compression. However, to our knowledge, there are no reports of vascular stent migration to intra-cardiac cavity causing AF. We present a case of endovascular stent migration into the cardiac cavities which could have triggered the AF in presence of other risk factors.
Introduction:Unfractionated heparin is the commonly used catheter lock solution in patients with temporary dialysis catheters as hemodialysis access. The effectiveness of trisodium citrate as an alternate catheter lock agent has not been studied in Asian population.Methods:In this prospective quasi-experimental study, which included 180 patients with central venous dialysis catheter, patients were randomly allotted to citrate 4.67% and heparin 5000 units/ml arms in the ratio of 2:1. Baseline demographic and dialysis related data, incidence of catheter-related bloodstream infections, and mean catheter days in both the study cohorts were collected and compared. Formal cost analysis for citrate 4.67% use as catheter lock was done.Results:The mean age of the total study population was 50.49 ± 14.87 years. Sixty-six females (36.7%) and 80 (44.4%) diabetic patients were included in the study. The overall incidence of catheter-related bloodstream infection (CRBSI) was 11.11%. The majority had nontunneled dialysis catheters (95%; n = 114). On analyzing the data of patients with nontunneled catheters, it was found that the total number of catheter days for the citrate and heparin groups were 4,795 and 2,419 days, respectively. The number of CRBSI episodes per 1,000 catheter days for the citrate and heparin groups were 2.711 and 2.89, respectively. Citrate catheter lock cost only 6% of that of heparin lock.Conclusions:The incidence of catheter related bloodstream infections was comparable between the heparin and citrate 4.67% lock cohorts. The use of low concentration citrate as catheter lock was cost-effective when compared with heparin.
UNSTRUCTURED Introduction: Cardiovascular disease is a major cause of morbidity and is now the leading cause of death in patients with renal transplants. We report a case of acute myocardial infarction three weeks post renal transplant. Case Report: A 45 year old male renal transplant renal transplant recipient presented three weeks post-transplant with acute chest pain, hypotension and atrial fibrillation. He was found to have Infero-posterior wall myocardial infarction. He was thrombolysed with Tenectaplase, and developed a perinephric hematoma six hours later. He underwent transfusions and pigtail drainage of the hematoma. The hematoma resolved, and he was started on dual anti-platelets with stable renal function. Conclusion: Thrombolysis in the early post-transplant period is considered a very high risk procedure. Our case illustrates the use of the thrombolytic therapy in the early post transplant period and successful management of the attendant complications.
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