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Abstract: PO1047

Hemorrhagic Shock due to Cutting of the Tunneled Dialysis Catheter

Session Information

Category: Dialysis

  • 703 Dialysis: Vascular Access

Authors

  • Bogdan, Lucia, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
  • Malavade, Tushar Suryakant, Toronto General Hospital, Toronto, Ontario, Canada
Introduction

Bleeding is a relatively rare complication of dialysis CVC overall.

Case Description

We describe the case of a 68-year-old non English speaking dementia patient with ESRD on HD. While in hospital, he had tried to cut the tape that was causing itching, but accidentally cut CVC. He was found in shock, bleeding from the exit site, which required aggressive resuscitation and compression to stop bleeding. After stabilisation examination revealed a palpable, well retracted catheter that was not visible (Fig 1). X ray showed the catheter in situ, but the Y along with the arterial and venous ports were absent (Fig 2). In retrospect, bleeding was particularly difficult to control because the cuff at this location is rigid and not compressible. This places the patient at increased risk for exsanguination leading to hemorrhagic shock, air embolism and mortality.

Discussion

To our knowledge, this is the first report of a cut tunnelled CVC proximal to the Y. This case demonstrates the risk of significant hemorrhage when a tunnelled CVC is damaged at this location and need for early recognition and control of bleeding. It also highlights important patient safety considerations given the risk of self-inflicted trauma in patients with dementia and language barrier for communication.

Catheter palpable, but not seen.

X Ray showing the retained tunnelled catheter proximal to Y