Diferencia entre revisiones de «Infection of AV fistula»
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==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== | ||
Revisión del 06:18 12 dic 2014
Background
- Dialysis catheter–related bacteremia is common and potentially life-threatening
Clinical Features
- Pts often p/w signs of systemic sepsis (fever, hypotension, leukocytosis)
- Classic signs of pain, erythema, swelling, d/c 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 cx 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