Managing Dialysis Fistula Emergencies

Show Notes

Take Home Points

1. On any dialysis patient, make sure to do a good assessment of their access site.  If it’s a fistula, assess for a thrill, for any warmth/induration/erythema and make sure they have distal sensation and perfusion.  If it’s a catheter, evaluate for any signs of infection—so warmth, erythema or discharge.
2. Bleeding is a big concern. If the patient is bleeding from their access, start with direct pressure to the bleeding site, then move on to topical thrombotic agents and if needed throw a figure 8 stitch with a 5-0 proline on a non-cutting needle.
3. Peritoneal dialysis patients are at risk for bacterial peritonitis.  In a PD patient that appears infected, get a peritoneal fluid sample and start antibiotics
4. Dialysis patients are susceptible to dialysis disequilibrium syndrome which can present as altered mental status, focal neurological deficits or even frank coma or seizures after dialysis.  Make sure to consider a broad differential in these patients and start with a solute load such as an amp or two of D50 while starting your work up.

Core EM: Hyperkalemia

Core EM: Episode 7.0 – Hyperkalemia + Rate Control in AFib

Al Sacchetti: ED Repair of Bleeding Dialysis Shunt

EM: RAP: Episode 107 – Dialysis Emergencies

EMBlog Mayo Clinic: How to Stop a Post-Dialysis Site Bleeding

emDocs: Managing Fistula Complications in the Emergency Department