Diferencia entre revisiones de «Infection of AV fistula»
(Text replacement - "==Sources==" to "==References==") |
(Text replacement - " cx " to " culture ") |
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| Línea 11: | Línea 11: | ||
==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== | ||
Revisión del 01:50 7 jul 2016
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, 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