Delayed malposition of a double-lumen hemodialysis catheter that caused hemorrhage and hypovolemic shock

Abstract

Rationale:Double-lumen hemodialysis catheters are commonly used as temporary hemodialysis routes. Complications include infection, thrombosis, cardiac arrhythmia, entrapped guide wire, and malposition. We report a rare complication of delayed hemodialysis catheter malposition that caused retroperitoneal hemorrhage and hypovolemic shock during hemodialysis.Patient concerns:A 72-year-old female patient who was receiving hemodialysis was referred to our emergency department because of general discomfort and decreased blood pressure (BP) after her regular hemodialysis. She had undergone surgery for a left forearm arteriovenous pseudoaneurysm and received a temporary hemodialysis catheter insertion via the left femoral vein 2 weeks before. The initial blood examination revealed a mildly decreased baseline hemoglobin level (7.2 g/dL) and hyperkalemia (5.9 mmol/L). Her BP recovered after fluid resuscitation. She was administered hemodialysis again, following which her BP reduced and a change in consciousness developed.Diagnosis:Chest and abdominal computed tomographies were performed to exclude acute vascular problems and showed a hemodialysis catheter tip protruding from the left iliac vein and hematoma in the left retroperitoneal space and pelvic cavity.Interventions:Intubation, fluid resuscitation, vasopressor administration, and blood transfusion were performed. She was admitted to the intensive care unit. The left femoral hemodialysis catheter was removed.Outcomes:Follow-up computed tomography revealed resolution of the retroperitoneal space hematoma. She was transferred to the ordinary ward 18 days later with a stable hemodynamic status. Unfortunately, she developed hospital-acquired pneumonia and arteriovenous shunt infection, and died from respiratory failure and sepsis on the 34th day in our hospital.Lessons:Femoral double-lumen catheter malposition is rare and potentially fatal. Emergency physicians should be aware of situations wherein a patient's BP declines markedly soon after a hemodialysis initiation.

The importance of imaging methods in catheter dysfunction: Two rare cases and their management

“…Malposition of cuffed-tunneled hemodialysis catheter may cause ineffective dialysis, and even fatal outcomes. [1,3] Malposition of the jugular or subclavian doublelumen central venous catheter is not an uncommon complication. The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF-DOQI) guidelines recommend routine chest X-ray to detect potential complications and to confirm the placement of the catheter after jugular and subclavian catheter insertion.…”

Procalcitonin for predicting catheter-associated bloodstream infection

“…[1] CVC use has been associated with many complications. [2][3][4] Catheterassociated bloodstream infection (CABSI) is one of the most common intractable healthcare-associated infections because catheters can be easily contaminated by bacteria and are associated with high mortality. [3,[5][6][7] An estimated 250,000 cases of CABSI occur in the United States annually, with 10% mortality rate.…”