Mitropoulou Athanasia, Lehmann Hendrik, Heier Evelyn M, Schneider Matthias, Hassdenteufel Esther
Department of Veterinary Clinical Sciences, Small Animal Clinic, Justus-Liebig-University Giessen, Giessen, Germany.
Front Vet Sci. 2021 Jul 5;8:691472. doi: 10.3389/fvets.2021.691472. eCollection 2021.
A 4-year-old female Boxer was referred for renal replacement therapy 2 days after observed grape ingestion. An 11-French dual-lumen dialysis catheter was placed into the right jugular vein and continuous renal replacement therapy was initiated for 66 h. Afterwards the patient received enoxaparin subcutaneously as a thromboprophylaxis. Four hours after removal of the dialysis catheter the patient developed severe dyspnea with hypercapnia and signs of hemorrhagic shock. Bedside ultrasound and X-rays of the thorax revealed a soft tissue opacity dorsally of the trachea, located in the mediastinum. The findings were consistent with mediastinal bleeding and hematoma formation. Blood gas examination indicated hypoventilation. The dog was managed conservatively with multiple blood transfusions and mechanical ventilation. The patient survived to discharge, and the hematoma was fully absorbed in the radiographs after 17 days. Patients with impaired kidney function should receive individualized enoxaparin dosage adjusted to anti-Xa levels and should be strictly monitored for complications. Mediastinal hemorrhage and hematoma formation should be considered as a potential complication in patients receiving a jugular vein catheter.
一只4岁雌性拳师犬在被观察到摄入葡萄两天后被转诊接受肾脏替代治疗。一根11法式双腔透析导管被置入右颈静脉，并开始进行持续肾脏替代治疗66小时。之后，患者皮下注射依诺肝素进行血栓预防。拔除透析导管4小时后，患者出现严重呼吸困难、高碳酸血症和出血性休克体征。床边超声和胸部X线检查显示气管背侧纵隔内有软组织密度影。这些发现与纵隔出血和血肿形成一致。血气检查提示通气不足。这只狗通过多次输血和机械通气进行保守治疗。患者存活至出院，17天后血肿在X线片上完全吸收。肾功能受损的患者应根据抗Xa水平调整依诺肝素剂量，并应严格监测并发症。接受颈静脉导管置入的患者应考虑纵隔出血和血肿形成这一潜在并发症。
