Figure 59

Extravasation injury to the access site. A, A relatively fresh segment of polytetrafluoroethylene graft was removed during a revision procedure. There is virtually no fibrosis or calcification (associated with repeated puncture). The luminal surface displays the results of multiple sites of puncture and healing. Among the most dramatic and troublesome complications of dialysis is access infiltration. In most cases the infiltration is minor and usually results from either inadequate hemostasis at the end of dialysis or needle perforation through the access site. Extravasation injury to the access is more likely when a needle errantly transfixes a graft or vein or when it accidentally becomes dislodged into the subcutaneous tissue. The venous return needle presents the biggest problem. In the face of typical pump speeds of 400 to 500 mL/min a potentially huge volume of fluid can enter the soft tissue before the pump stops in response to the alarm for elevated venous pressure. In many cases, the graft is unusable for weeks after such an episode. Continued use of the access in this setting may result in loss of the access site. B, In this example, the infiltration was composed of approximately 400 mL of priming crystalloid and blood, located both deep and superficial to the investing fascia of the arm. The access remained patent and was eventually restored to function; however, a series of percutaneous drainage procedures and open drainage were necessary. Compartment syndrome, with loss of distal motor function or sensation in the arm, is another concern in this setting, and drainage must be performed to treat this surgical emergency.

0 0

Post a comment