Diferencia entre revisiones de «Infection of AV fistula»
Sin resumen de edición |
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==Clinical Features== | ==Clinical Features== | ||
* | *Often presents with signs of systemic [[sepsis]] ([[fever]], [[hypotension]], leukocytosis) | ||
**Classic signs of pain, erythema, swelling, | **Classic signs of pain, erythema, swelling, discharge from infected access are often missing | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Workup== | ==Workup== | ||
*Draw peripheral and catheter [[blood cultures]] simultaneously | *Draw peripheral and catheter [[blood cultures]] simultaneously | ||
**4x higher colony count in catheter blood | **4x higher colony count in catheter blood culture suggests catheter is source of bacteremia | ||
==Management== | ==Management== | ||
*Give [[vancomycin]] 1gm IV +/- | *Give [[vancomycin]] 1gm IV +/- [[gentamicin]] 100mg IV (if [[gram neg]] suspected) | ||
*Do not remove dialysis patient's access | *Do not remove dialysis patient's access | ||
**Catheter is only removed if fever persists for 2-3d after | **Catheter is only removed if [[fever]] persists for 2-3d after [[antibiotics]] are started | ||
==Disposition== | ==Disposition== | ||
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==External Links== | ==External Links== | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category:Renal]] | |||
[[Category:Vascular]] | |||
[[Category:ID]] | |||
Revisión actual - 17:11 16 oct 2019
Background
- Dialysis catheter–related bacteremia is common and potentially life-threatening
Clinical Features
- Often presents with signs of systemic sepsis (fever, hypotension, leukocytosis)
- Classic signs of pain, erythema, swelling, discharge from infected access are often missing
Differential Diagnosis
AV Fistula Complications
- Clotting of AV fistula
- Infection of AV fistula
- Hemorrhage of AV fistula
- Vascular insufficiency from AV fistula
- AV fistula aneurysm/pseudoaneurysm
- High-output heart failure from AV fistula
Workup
- Draw peripheral and catheter blood cultures simultaneously
- 4x higher colony count in catheter blood culture suggests catheter is source of bacteremia
Management
- Give vancomycin 1gm IV +/- gentamicin 100mg IV (if gram neg suspected)
- Do not remove dialysis patient's access
- Catheter is only removed if fever persists for 2-3d after antibiotics are started
Disposition
- Admit