Recognizing a hemodialysis fistula and graft infections
In this video, from our Dialysis Essentials course, we'll cover the various cannulation techniques used with dialysis patients, the levels of risk posed (in terms of developing infections), and what to do if an infection develops.
Late recognition and treatment of infections in dialysis patients are significant causes of hospitalization, morbidity, and mortality. In this video, from our Dialysis Essentials course, we'll cover the various cannulation techniques used with dialysis patients, the levels of risk posed (in terms of developing infections), and what to do if an infection develops.
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Delayed recognition and treatment of infections and dialysis patients are important causes of hospitalization, morbidity, and mortality. Access site infections are typically caused by the introduction of skin contaminants at the time of cannulation. central venous catheters have the highest rate of infection, followed by arteriovenous grafts arteriovenous fistulas have the lowest rate of infection.
Infections associated with fistulas are rare. Since no artificial material is present, there are two methods for cannulation the placement of needles into a fistula the preferred method is known as the rope ladder cannulation. It uses sharp dialysis needles with rotation of the cannulation sites from one treatment to the next.
The rope ladder technique requires a single antiseptic application to the skin prior to cannulation and is associated with the lowest rate of infection. buttonhole. cannulation is the creation of subcutaneous tracks between the skin and the fistula, similar to tracks created when piercing ears. cannulation is with blunt needles inserted repeatedly into the fistula through these tracks.
The buttonhole technique is associated with reduced formation of pseudo aneurysms. With buttonhole cannulation a scab forms at the cannulation site. After swabbing the skin with chlorhexidine the scab is removed in the skin is swab the second time failure to remove the scab and re sterilize the skin prior to cannulation can introduce bacteria from the scab into the bloodstream.
Bacteria can also colonize within the subcutaneous tracks if cannulation is performed incorrectly. due to the increased risk of infections, the buttonhole technique is used less often these days. grafting infections are more common than fistula infections, since they contain foreign money. Most will present with fever err Thema in tenderness over the graft.
Sometimes there might be purulent drainage from the graft needle sites. graft infections are most common within six months of creation, but can be observed later. Usually graft excision is required with systemic antibiotics. Sometimes in minor infections that are localized, you can do a partial excision and placement of a jump graft, which bypasses the problem area.
Diagraphs have a higher risk of infection than upper extremity grafts. Usually, upper extremity graft infections are caused by gram positive bacteria. By graft infections more often result from Gram negative bacteria. So empiric antibiotic coverage will need to consider this difference.