Sood Vivek, Kumar Vivek, Rathi Manish, Pattanashetty Navin, Ramachandran Raja
Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Indian J Nephrol. 2021 Jan-Feb;31(1):54-56. doi: 10.4103/ijn.IJN_330_19. Epub 2021 Jan 27.
Guidewire embolism during venous access for haemodialysis is not uncommon yet potentially avoidable iatrogenic complication. Unrecognised, long-standing guidewire may predispose to thrombosis and become a nidus for infection. This entity should always be borne in mind and considered as one of the differentials of unexplained pyrexia in patient on maintenance haemodialysis. In this context, we report a patient on maintenance dialysis who presented with fever of 6 weeks duration with no localising history and failed response to empirical antibiotics. On imaging, he was detected to have guidewire with fracture embolism into inferior vena cava and right external iliac vein and soon patient became afebrile following guidewire retrieval using gooseneck snare device, thereby retrospectively confirming causality.
血液透析静脉通路期间的导丝栓塞是一种并不罕见但有可能避免的医源性并发症。未被识别的、长期存在的导丝可能易引发血栓形成并成为感染病灶。在维持性血液透析患者中,应始终牢记这一情况,并将其视为不明原因发热的鉴别诊断之一。在此背景下,我们报告一例维持性透析患者,该患者持续发热6周,无定位病史,经验性使用抗生素治疗无效。影像学检查发现,他的导丝断裂并栓塞至下腔静脉和右髂外静脉,使用鹅颈圈套器取出导丝后患者很快退热,从而回顾性地证实了因果关系。