Chen I-Chen, Yang Shih-Chia, Liu Kuan-Ting, Wu Yen-Hung
Department of Emergency Medicine, Kaohsiung Medical University Hospital.
School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Medicine (Baltimore). 2019 Jan;98(3):e14192. doi: 10.1097/MD.0000000000014192.
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.
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.
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.
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.
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.
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.
双腔血液透析导管通常用作临时血液透析通路。并发症包括感染、血栓形成、心律失常、导丝嵌顿和位置异常。我们报告了一例罕见的延迟性血液透析导管位置异常并发症，该并发症在血液透析期间导致腹膜后出血和低血容量性休克。
一名72岁接受血液透析的女性患者，因常规血液透析后全身不适和血压下降被转诊至我院急诊科。她曾因左前臂动静脉假性动脉瘤接受手术，并在2周前经左股静脉插入临时血液透析导管。初始血液检查显示基线血红蛋白水平轻度下降（7.2g/dL）和高钾血症（5.9mmol/L）。经液体复苏后她的血压恢复。再次进行血液透析后，她的血压下降并出现意识改变。
进行胸部和腹部计算机断层扫描以排除急性血管问题，结果显示血液透析导管尖端从左髂静脉突出，左腹膜后间隙和盆腔有血肿。
进行了插管、液体复苏、血管加压药给药和输血。她被收入重症监护病房。拔除了左股静脉血液透析导管。
随访计算机断层扫描显示腹膜后间隙血肿消退。18天后她被转至普通病房，血流动力学状态稳定。不幸的是，她发生了医院获得性肺炎和动静脉分流感染，并在我院第34天死于呼吸衰竭和脓毒症。
股静脉双腔导管位置异常罕见且可能致命。急诊医生应意识到患者在开始血液透析后不久血压明显下降的情况。
