Blood Loss through AV Fistula: A Case Report and Literature Review

Saeed, Fahad; Kousar, Nadia; Sinnakirouchenan, Ramapriya; Ramalingam, Vijaya Sivalingam; Johnson, Philip B.; Holley, Jean Lake

doi:10.4061/2011/350870

Cited by 25 publications

(28 citation statements)

References 37 publications

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“…Physical examination of an aneurysm is the most important tool to determine the need for an intervention (Figure 4). Any rapidly enlarging PSA, evidence of outflow stenosis (arm elevation test-failure to collapse, high-pitch bruit), thinning or ulceration of skin over the PSA, pulsatility, or evidence of infection should prompt urgent intervention (121,123). Proper cannulation techniques may prevent PSA formation.…”

Section: Vascular Access Hemorrhagementioning

confidence: 99%

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Diagnosis, Treatment, and Prevention of Hemodialysis Emergencies

Saha

Allon

2016

CJASN

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Given the high comorbidity in patients on hemodialysis and the complexity of the dialysis treatment, it is remarkable how rarely a life-threatening complication occurs during dialysis. The low rate of dialysis emergencies can be attributed to numerous safety features in modern dialysis machines; meticulous treatment and testing of the dialysate solution to prevent exposure to trace elements, toxins, and pathogens; adherence to detailed treatment protocols; and extensive training of dialysis staff to handle medical emergencies. Most hemodialysis emergencies can be attributed to human error. A smaller number are due to rare idiosyncratic reactions. In this review, we highlight major emergencies that may occur during hemodialysis treatments, describe their pathogenesis, offer measures to minimize them, and provide specific interventions to prevent catastrophic consequences on the rare occasions when such emergencies arise. These emergencies include dialysis disequilibrium syndrome, venous air embolism, hemolysis, venous needle dislodgement, vascular access hemorrhage, major allergic reactions to the dialyzer or treatment medications, and disruption or contamination of the dialysis water system. Finally, we describe root cause analysis after a dialysis emergency has occurred to prevent a future recurrence.

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Section: Vascular Access Hemorrhagementioning

confidence: 99%

“…Proper cannulation techniques may prevent PSA formation. Rope ladder technique prevents aneurysm formation, whereas repeated cannulation of the same area may promote aneurysm formation (123).…”

Section: Vascular Access Hemorrhagementioning

confidence: 99%

Diagnosis, Treatment, and Prevention of Hemodialysis Emergencies

Saha

Allon

2016

CJASN

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“…Aneurysms could be pseudo-aneurysms or true aneurysms 7 . Pseudoaneurysms develop over a short period and are usually saccular with thin overlying skin and are formed outside the vessel wall, while true aneurysms are fusiform under the nonulcerated skin and develop over time 9 . Some authors define the aneurysm as more than three times dilatations of the native vessel diameter size, with the minimum diameter size of 2 cm 7 .…”

Section: Discussionmentioning

confidence: 99%

“…Aneurysm formation is the most common cause of acute access blood loss in patients on hemodialysis 9 . One of the main factors contributing to the AVF true aneurysm formation is repeated puncture/needling 6,9,11 .…”

Section: Discussionmentioning

confidence: 99%

Arteriovenous Fistula Aneurysm

Al-Agha¹,

Alqaseer²,

Shehab³

2016

BMB

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Chronic renal failure patients need renal replacement therapy to sustain their lives. Renal replacement therapy could be either hemodialysis (HD) or peritoneal dialysis (PD). In hemodialysis, a vascular access is created to connect the patient to the dialysis machine; the access could be a central line, a native arterio-venous fistula (AVF) or a synthetic arteriovenous graft (AVG) 1 . AVF provides the best functional patency and the least complications 1 . AVF is the recommended vascular access in patients who need dialysis treatment 2 . Nevertheless, complications, such as AVF aneurysms, steal syndrome, venous hypertension and infections are not uncommon 3 .A recent study on regular hemodialysis patients revealed that AVF aneurysm formation is the most common complication 3 . Background: Arterio-venous fistula (AVF) provides the best functional patency for patients onregular hemodialysis (HD). Nevertheless, complications such as AVF aneurysms, steal syndrome, venous hypertension and infections are not uncommon. Objective: To evaluate the trends in AVF aneurysm formations, prophylaxis and treatment options. Design: A Retrospective, Descriptive Study. Setting: Hemodialysis Centers, Ministry of Health, Kingdom of Bahrain. Method: Two hundred and eleven patients on hemodialysis via arterio-venous fistula and arteriovenous graft were included in the study. Result: Two hundred and eleven patients were on hemodialysis via arterio-venous fistula and arterio-venous graft. Thirty (14.22%) patients developed arterio-venous fistula aneurysm. Sixteen (53.33%) were males, and the mean age was 57 years. Eleven (36.66%) patients had excision of the aneurysms with interposition graft. Six (20%) patients had excision of the aneurysms with new fistula formation. Six (20%) patients required a change of the cannula insertion site while the remaining 7 (23.33%) patients were waiting for their scheduled date of surgery. Conclusion: Aneurysm formation is the most common complication in post AVF patients on regular HD. AVF aneurysms are at high risk of rupture and fatal hemorrhage. Surgical treatments could safely be performed for high risk aneurysms. The most common cause of aneurysm formation is repeated punctures at the same site.

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“…Vascular access site infection is considered to be the most challenging complication and the major cause of morbidity and mortality among chronic hemodialysis patients. 17 It is also an important cause for AV fistula failure. Taking proper hygienic measures reduce the rate of infection in AV fistula, increases its patency and functional duration, in our study population 63.1% knows about the importance of washing AV fistula and arm before hemodialysis session and 64.5% were practicing it, regarding the age only 61.2% in age group under 40 years were practicing, the practice ratio increased up to 74.6% in age group 40 to 60 years with again fall to 0% in patients more than 60 years of age as in manual compression practice.…”

Section: A Major Barrier To Increasing the Number Ofmentioning

confidence: 99%

Arteriovenous Fistula Care

Iqbal¹,

Shareef²,

Afzal

et al. 2018

TPMJ

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Objectives: To determine knowledge, attitude and practice regarding AV fistula care in patients of end stage renal disease on hemodialysis. Study Design: Cross sectional study. Setting: ESRD patients in Nephrology Department of Lahore General Hospital by using self-designed questionnaire. Period: Six months from Jan 2017 to June 2017. Method: The study included about 141(consecutive sampling) patients of chronic kidney disease using AV fistula for hemodialysis. Data was collected using self designed questionnaire. Data analysis was done using SPSS version 22. Result: The most well-known precautionary measures to be taken for arteriovenous fistula care are to avoid taking blood pressure and intravenous line on the arm bearing AV fistula and to avoid trauma and weight lifting with that limb. The knowledge was seen to be particularly deficient about the measures to be taken in case of swelling. The attitude towards AV fistula care was observed to be positive, majority of our study population claimed to follow maximum precautionary measures most of the time, but percentage of practicing does not coincide with that (85.1% vs.74.7% respectively). The least practiced measure is elevation of limb in case of swelling, observed by only 36.9% of our study population. Conclusion: Knowledge regarding fistula care was adequate about most of the precautionary measures, most of the participants showed positive attitude towards practicing precautionary measures for fistula care, but number of patients actually practicing these precautions is less than the number of patients that have knowledge about them.

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Blood Loss through AV Fistula: A Case Report and Literature Review

Cited by 25 publications

References 37 publications

Diagnosis, Treatment, and Prevention of Hemodialysis Emergencies

Diagnosis, Treatment, and Prevention of Hemodialysis Emergencies

Arteriovenous Fistula Aneurysm

Arteriovenous Fistula Care

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