Complications of vascular access in patients- undergoing haemodialysis at the Kenyatta National Hospital
Abstract
Between July, 1990 and February, 1991, a total of thirty seven (37) patients
on intermittent. haemodialysis were studied for vascular access complications and
difficulties. Twenty-three (62.0%) wet e males and Ioui teeu (38%) were fenHtleb.
Their ages ranged between 10-62 years with a mean age of 32.2 ± 6.8 (2 SD).
Sixteen (41%) patients had subclavian vein catheter (SVC), five (13%) had
arteriovenous shunts (AVS) and eighteen (46%) had arteriovenous fistulae (AVF).
The mean survival time of a vascular access is the duration or survival of a particular
vascular access in months [or weeks). It was deter mined by the number
of patients-months of dialysis divided by the number of vascular access insertions
or creations. The mean arterial (or venous) caunular survival time fur AVS was 3
months, for SVC was 3 months and for AVF was 9 months.
Thirty two (60%) of the patients on haemodialysis had vai ious complications
related to the vascular accesses. Eight (50%) of the SVC were infected. One
(2070) of the AVS was infected. Not. a single case of infected A\T was encounteredo
Out of the nine infected vascular accesses, staphlococcus aureus was grown
in five (55%). Four (25%) patients with SVC had thrombus formation in the
catheters. Two (40%) patients with AVS had thrombus formation in the tubing.
One (5.5%) patient. with AVF had a clot. Iounation in the needle used Ior needling
the AVF. Two (12.5%) patients, who haJ previous SVC developed subclavian vein
thrombosis which resulted into massive swelling of the whole upper limb. This
is a rare vascular access complication when compared with other vascular access
complications. One (20%) patient with AVS and another one (5.5%) with AVF
had bleeding episode from the vascular access. No bleeding episode was encountered
in SVc. Two (12.5%) patients had SVC inserted into the internal jugular
vein instead of the superior vena cava. One patient developed a haematoma aftel
AVF creation. One patient (5.5%) with AVF developed radial "artery steal"
syndrome. Three (16.7%) patients with AVF created in the antecubital fossa had
difficult needling during haemodialysis. Five (27.8%) patients had AVF created
which failed to function within 2-4 hours of creation. The catheters came out from
two (12.5%) patients with SVC because of loose anchoring stitch.
From this study, it is suggested that check x-rays after SVC insertion should
be mandatory. SVC and AVS should not be used for more than 3 months because chances
of complications increases drastically after 3 months. Coagulation
screening should be carried on all patients scheduled for AVF creation. Patients
should be well hydrated before AVF creation to avoid hypotension a major reason
for failed AVF. Patients Blood Pressure should be well controlled before AVF creation
to avoid hypotension which also leads to AVF failure to function. Anchoring
stitches should be firmly stitched and if they come out, they should be re-stitched
immediately. Vascular surgeons should be advised to avoid creating AVF in the
antecubital fossa because of the difficult in needling of these fistulae. In addition:
the vascular surgeons should make sure that the created AVF are subcutaneous
for easy needling during haemodialysis.
Citation
Degree of Master of Medicine (Internal Medicine) in the University of NairobiPublisher
University of Nairobi School of Medicine
Description
A dissertation submitted in partial fulfillment
for the Degree of Master of Medicine (Internal
Medicine) in the University of Nairobi