Three near fatal or fatal complications during implantation of tunnelled hemodialysis catheters

Abstract

Tunnelled hemodialysis catheters are well accepted and widely used devices to provide vascular access for dialysis in patients when an arteriovenous shunt is not feasible or dysfunctional. In the literature complications after implantation are well documented but fatal or near-fatal events during implantation are seldom reported. In this article 3 such cases from a single tertiary center over a period of more than 10 years are presented and discussed. The (near) fatal complications occurred despite experienced surgeons and the use of ultrasound and fluoroscopy during implantation. Although the incidence is estimated to be much less than 1% at this centre, implantation of a tunnelled hemodialysis catheter is demanding, a thorough evaluation of vascular structures in advance is mandatory and experiencend professionals with high index of suspicion are essential. Performing the procedure with the patient under conscious sedation has benefits compared to general anesthesia. If the patient indicates atypical pain, the procedure should be stopped immediately and re-evaluated for any cause. If a perforation with relevant vascular damage is suspected, we recommend leaving the dilator/introducer/catheter in place to reduce major hemorrhage until the vascular or cardiothoracic surgeon can fix the problem.

Die psychiatrische Kompetenz im hausärztlichen Bereich muss gestärkt werden – Kontra

“…Bedeutsam ist weiterhin die Notwendigkeit der Vernetzung verschiedener an der Behandlung einer Patientin/eines Patienten beteiligten Leistungserbringer, wie Beispiele aus der Schmerztherapie zeigen. Effizient und effektiv sind multiprofessionelle Behandlungsansätze, vor allem unter Einbeziehung der psychiatrisch-psychotherapeutischen sowie der psychosomatischen Expertise 5 . Für onkologische Erkrankungen wurde, nach dem in einem Gutachten des Sachverständigenrats beschriebenen Bedarf 6 , eine Leitlinie erarbeitet, welche psychoonkologische Elemente skizziert 7 .…”