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Patient has a tunneled hemodialysis catheter in her left internal jugular vein and has had multiple episodes of cathe PowerPoint Presentation
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Patient has a tunneled hemodialysis catheter in her left internal jugular vein and has had multiple episodes of cathe - PowerPoint PPT Presentation


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hemodialysis catheter has been removed. left IJ. Patient has a tunneled hemodialysis catheter in her left internal jugular vein and has had multiple episodes of catheter dysfunction due to formation of a fibrin sheath. fibrin sheath. Fibrin sheath and left brachiocephalic vein

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Patient has a tunneled hemodialysis catheter in her left internal jugular vein and has had multiple episodes of cathe


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Presentation Transcript
slide1

hemodialysis catheter

has been removed

left IJ

Patient has a tunneled

hemodialysis catheter in her

left internal jugular vein

and has had multiple episodes

of catheter dysfunction

due to formation of a fibrin sheath

fibrin sheath

slide2

Fibrin sheath and

left brachiocephalic vein

have been dilated

several times

slide3

Due to the long-term

presence of the tunneled

hemodialysis catheter

there is a persistent

stenosis in the

left brachiocephalic vein

This central venous stenosis.

in combination with her

new left upper arm fistula,

is the etiology of her

persistent left upper

extremity swelling

slide4

A good management plan would be to remove the

tunneled hemodialysis catheter from the left internal jugular vein

and then to dilate (PTA) and stent the stenosis in the left

brachiocephalic vein to alleviate the left arm edema.

To do so requires moving the hemodialysis catheter to a new

location. Ultrasound demonstrated that the right internal jugular

vein is occluded. The right subclavian vein may be an option

if the right upper extremity veins are not useable for future

vascular access procedures.

A right upper extremity venogram was performed.

slide5

cephalic vein

basilic vein

Right elbow region

slide6

cephalic vein

basilic vein

Right upper arm veins

slide7

cephalic vein

subclavian vein

basilic vein

Right shoulder region

slide8

Moderate stenosis of mid-subclavian vein

due to extrinsic compression of vein

between 1st rib and right clavicle

slide9

The right basilic vein is in decent shape and could be

used for a future fistula or graft. Therefore, we would

not want to jeopardize the right subclavian by using

it for a new tunneled hemodialysis catheter.

The next option would be to remove the current

left-sided tunneled hemodialysis catheter and place a

new tunneled hemodialysis catheter into a femoral vein.

This option should be discussed with the patient.