Abstract: FR-PO650
Potential Anaphylactic Shock Related to Tunneled Hemodialysis Catheter Material
Session Information
- Trainee Case Reports - IV
October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 704 Dialysis: Vascular Access
Authors
- Elliott, Andrew B., Medical University of South Carolina, Charleston, South Carolina, United States
- Jenssen, Fredrik, Medical University of South Carolina, Charleston, South Carolina, United States
- Dossabhoy, Neville R., LSUHSC-Shreveport, Shreveport, Louisiana, United States
- Fulop, Tibor, Medical University of South Carolina, Charleston, South Carolina, United States
- Asfar, Waleed, Medical University of South Carolina, Charleston, South Carolina, United States
Introduction
We report a most concerning case of likely allergic reaction related to tunneled dialysis catheter (TDC) polyurethane material, manifesting with anaphylactic shock and culminating in the patient’s death.
Case Description
The index case of a 57-year-old male veteran with end-stage renal disease, diabetes mellitus, obesity, and sleep apnea had been receiving in-center maintenance hemodialysis for nine years. Due to an interval left arterio-venous upper extremity fistula malfunction, he received a tunneled dialysis catheter (TDC) [major manufacturer; 23 cm, 14.5 French dual-lumen catheter] in the right internal jugular position. Of note, this was his first catheter access. Shortly after TDC placement, he complained of diffuse and severe itching; however, no hives or respiratory difficulties were observed. Approximately 12 hours after TDC placement, he presented for his scheduled chronic dialysis. Immediately after start (1-2 min), he complained of intolerable whole body itching and requested termination of treatment; blood was not returned. Diffuse swelling of the tongue and face was observed with almost immediate full-blown hemodynamic collapse and cardiovascular arrest. A prolonged resuscitation attempt failed. Subsequent autopsy revealed severe cardiomegaly and atherosclerosis, but no clear or competing immediate cause of death. An extensive investigation of dialysis machine and water supply ruled out bacterial or chemical contamination. No other patients experienced any problems in the unit. Aside from the catheter use in this patient, there was no technological change in the facility (filter, sterilization) and his dialysis prescription was unchanged. An institutional Root Cause Analysis was also performed, which failed to disclose any other competing cause for cardiovascular arrest.
Discussion
To our knowledge, this is the first report of possible anaphylactic shock related to TDC polyurethane material. Diffuse itching soon after TDC placement (not related only to insertion site) should raise clinical suspicion and may indicate risk of hemodynamic collapse after blood starts flowing through the catheter. Also it is important to consider other entities that may cause allergic reaction that has not been discovered in this setting and possible differences in cleaning of VA dialysis machines vs other outpatient units to see differences arise.