Abstract
Even in patients with chronic renal failure and chronic intermittent hemodialysis, continuous venovenous hemofiltration (CVVH) is the most often practiced renal replacement technique in the intensive care unit. Although patients show less hemodynamic instability during CVVH than during hemodialysis, it requires a blood flow exceeding 200 ml/min in the extracorporeal circuit necessitating the use of large bore catheters. Vascular access in critically ill septic and edematous patients is sometimes difficult, or even impossible.We describe a technique of using a brachio-cephalic arterio-venous fistula in a hemodialysis patient for continuous hemofiltration (HF) resulting in improved hemodynamic stability.
Highlights
Even in patients with chronic renal failure and chronic intermittent hemodialysis (CIHD), continuous venovenous hemofiltration (CVVH) is the most often practiced renal replacement technique in the intensive care unit (ICU) with a filtration rate of at least 2 liters/hour [1]
CVVH requires a blood flow exceeding 200 ml/min in the extracorporeal circuit implicating the use of large bore catheters
We describe a technique of using a brachio-cephalic (BC) arterio-venous fistula in a hemodialysis patient for continuous hemofiltration resulting in improved hemodynamic stability
Summary
Even in patients with chronic renal failure and chronic intermittent hemodialysis (CIHD), continuous venovenous hemofiltration (CVVH) is the most often practiced renal replacement technique in the intensive care unit (ICU) with a filtration rate of at least 2 liters/hour [1]. A history of massive vomiting, an abdominal CT-scan and pathological examination of a peritoneal biopsy taken upon removal of the catheter led to a diagnosis of encapsulating peritoneal fibrosis Treatment for this disorder had been started with prednisolone and tamoxifen while intermittent HD was resumed on the well developed BC-fistula. Frequent hemodialysis was performed but was complicated by hypotension in spite of the use of vasopressor support and this therapy failed to reverse the severe edematous state. In view of this clinical dilemma, we decided to try hemofiltration by vascular access to the existing brachio-cephalic fistula. His hemodynamic state had improved in such a way that we successfully switched to intermittent HD
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