Suicidal Incised Wound of a Fistula for Hemodialysis Access in an Elderly Woman

Marc, B.; Baudry, Frédéric; Zerrouki, Latifa; Ghaith, Armel; Garnier, M.

doi:10.1097/00000433-200009000-00018

Cited by 19 publications

(10 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These include successful suicides by incision of an arteriovenous fistula and a second case involving division of a subclavian venous dialysis catheter [4, 5], both in patients undergoing haemodialysis. This is the first reported case of suicide by incision of a prosthetic vascular graft.…”

Section: Discussionmentioning

confidence: 99%

Novel Suicide by Division of a Chronically Infected, Externalised Axillofemoral Graft Presenting Challenges in Prehospital Assessment of Mental Capacity

Stevens

Roberts

2012

Case Reports in Emergency Medicine

View full text Add to dashboard Cite

Assessing a patient's competence to give informed consent in pre-hospital care is difficult. In the presented case an elderly patient attempted suicide by division of a chronically infected and externalised prosthetic arterial graft. He was able to comprehend his situation and understand the consequences of declining treatment. Without prior knowledge of his medical care and psychological state, however, we did not believe we could fully assess the patient's ability to act in his own best interest. After sedation and resuscitation he was transferred to hospital. This case report discusses a unique method of suicide and the challenge of obtaining valid consent in prehospital care.

show abstract

Section: Discussionmentioning

confidence: 99%

Novel Suicide by Division of a Chronically Infected, Externalised Axillofemoral Graft Presenting Challenges in Prehospital Assessment of Mental Capacity

Stevens

Roberts

2012

Case Reports in Emergency Medicine

View full text Add to dashboard Cite

show abstract

“…Therefore, the amount of extravasated blood may be less than would be expected for fatal hemorrhage in a healthy individual (11). Other authors have described suicides following disconnecting or severing of dialysis catheters (4,10,11) or incising of an AVF (9). In our case, the patient was able to achieve his suicidal goal while under one on one supervision.…”

Section: Discussionmentioning

confidence: 99%

“…The suicide rate among dialysis patients is significantly higher than in the general population (4–7). There have been previous reports of individuals committing suicide by severing or disconnecting their vascular access sites with resultant hemorrhage (4,8–11); however, there has been no previous report of exsanguination following biting into a vascular access site.…”

mentioning

confidence: 99%

Biting Through an Arteriovenous Hemodialysis Graft: An Unusual Method of Suicide

Charlot

deRoux

2009

Journal of Forensic Sciences

View full text Add to dashboard Cite

Patients on long-term hemodialysis often have multiple medical and social problems with associated psychological stress and depression. The suicide rate in this population is higher than the general population, and suicides have been reported following severing or disconnection of hemodialysis vascular access sites. We report a patient on chronic hemodialysis with a history of depression and suicidal ideation who bit into his forearm arteriovenous graft and exsanguinated.

show abstract

“…Intentional cutting of catheters as in case 1 is rare, and may be associated with underlying depression or psychiatric illness. It is estimated that 25 to 50% of patients undergoing dialysis experience depression and that the suicide rate is 1% [15,16]. For this reason careful psychiatric assessment of patients with these devices has been advised [16].…”

Section: Discussionmentioning

confidence: 99%

Forensic issues in cases of fatal hemorrhage from arteriovenous dialysis access sites

Byard

James

2007

Forens Sci Med Pathol

View full text Add to dashboard Cite

Angioaccess sites to enable repetitive vascular punctures for hemodialysis include temporary or permanent indwelling catheters, port access devices, autogenous vessels in native arteriovenous fistulas, or non-autogenous material in prosthetic arteriovenous grafts. While complications such as thrombosis and infection are well recognized, lethal hemorrhage is much less commonly encountered. In this paper, selected cases are reported to demonstrate the range of situations that may be encountered at autopsy, including hemorrhage from a catheter in a case of suicide, and hemorrhage from an arteriovenous fistula and an arteriovenous graft. Predisposing factors to hemorrhage include coagulation abnormalities due to anticoagulant therapy or to underlying renal failure, stenosis or obstruction that has resulted in increased intraluminal pressure, local sepsis, repeated trauma from venesection and hypertension. An approach to such cases should include careful evaluation of the medical history and death scene, with dissection at autopsy of catheters, grafts and fistulas to demonstrate the condition of anastomosis sites, and the presence or absence of ruptures, perforations, stenoses, and/or thromboses. Histologic sampling of autologous fistula walls and surrounding soft tissues may reveal evidence of sepsis.

show abstract

Suicidal Incised Wound of a Fistula for Hemodialysis Access in an Elderly Woman

Cited by 19 publications

References 11 publications

Novel Suicide by Division of a Chronically Infected, Externalised Axillofemoral Graft Presenting Challenges in Prehospital Assessment of Mental Capacity

Novel Suicide by Division of a Chronically Infected, Externalised Axillofemoral Graft Presenting Challenges in Prehospital Assessment of Mental Capacity

Biting Through an Arteriovenous Hemodialysis Graft: An Unusual Method of Suicide

Forensic issues in cases of fatal hemorrhage from arteriovenous dialysis access sites

Contact Info

Product

Resources

About