Ward Consult – 76-year-old man for consideration of urgent Fistula formation
- Bronchiectasis – previous haemophilus influenzae pneumonia
- Chronic Kidney Disease – Hypertensive and diabetic nephropathy
- Nephrectomy – Renal Cell Carcinoma
- Admitted to hospital with dyspnoea and worsening renal function
- CXR showed fluid overload and cardiomegaly.
- Echocardiogram performed – pericardial effusion
- Pericardiocentesis – 1.2 Litres drained!
- Significant discussions between treating teams regarding the need for AV Fistula to commence Haemodialysis
- Cardiology team advocating for a fistula. Concerned regarding uraemic cardiomyopathy as a cause of fluid overload and pericardial effusion
- Nephrology team of the opinion that uraemia is very unlikely to be the cause.
- Additionally, renal function was improving and if dialysis was required then it could be done via VasCath initially
- Discussion regarding the use of a fistula in the immediate postoperative period. There is often a 6-week delay to allow for maturation of vessels.
- Timing of fistula use is dependent on the use of native vessels vs Graft. Can be used earlier with graft.
- Discussion between all teams ultimately concluded that procedure wasn’t required at present