AV fistulas and lines. - page 2

by MLB55

8,136 Views | 19 Comments

Recently, I had a pt admitted to the ICU with a LUE av fistula and a LUE Picc line. He was hypotensive, so he got an art line... In his left radial. I was always under the impression that NO lines should be in the extremity, we... Read More


  1. 1
    Quote from MLB55
    He was that classic renal pt that got septic. I was there the day he got admitted, report sounded something like "last bp was 30/20"... Give fluids, intubate, put in lines, and than maxed on four pressors and cvvh. I was happy to see him headed in the right direction, the day before he had been tachy 180s-200s. That touch of dopa and max on Levo + sepsis... He was not looking good.I handed him over with maps in the 60s, HR in the 90s-120s. Still very very sick, but not actively circling the drain. And yes, the team was not worried about his long term access. He was also in ARDS. His plt goal was >10, pao2>55, map >55


    Interesting yes, but it's a teeter/totter exercize. Sounds like you done good.

    A pt. max'd out on pressors makes for a real fun dialysis experience. The ICU staff blame me when it all goes to hell (lovingly of course) .


    Hope the patient is doing better...full blown sepsis and ARDS does not often bode well.
    KarlyRN likes this.
  2. 0
    Guy is doing better today. He LOOKS alot better, actually has color and looks like he is 49 and not 79.He's on vaso with a touch of Levo (1-5 mcgs/min), both fem lines are removed and has a vas cath in the left IJ. But get this, they put a PICC in the LUE.......He still has the art in the right radial. he has come done on his vent rate and his ABGs look better. It'll be interesting to see how he does, almost time to lighten his sedation and see where we are at.
  3. 0
    Quote from MLB55
    Guy is doing better today. He LOOKS alot better, actually has color and looks like he is 49 and not 79.He's on vaso with a touch of Levo (1-5 mcgs/min), both fem lines are removed and has a vas cath in the left IJ. But get this, they put a PICC in the LUE.......He still has the art in the right radial. he has come done on his vent rate and his ABGs look better. It'll be interesting to see how he does, almost time to lighten his sedation and see where we are at.

    Was gunna ask about use of fem lines...

    Thanks for the update from your unique expertise.

    Hope he has a successful SBT soon.

    P.S. two weeks ago I had a pt. that extubated himself, then was promptly reintubated (duh) as he subsequently failed his "self induced SBT" ).

    Then, it was decided he'd need to be trach'd and sent to a vent farm for any hope of lont term survival...

    ...long story short due to his unique (C-spine) anatomy, the surgeon found he was not a candidate for a trach. ET was pulled with a Hail Mary pass.... and the man survived. And he's currently doing well!

    He's a lovely man, one of my favorites and it just goes to show...one never knows.
  4. 0
    Oh, wow. I work in a large teaching hospital in a Neuro ICU and I have never seen a pt that was not a candidate for a trach... C spine injuries and all. You truly just never know until it happens.Vent farm, I like that...I had the guy today again actually. Weaned off the Levo with a few fluid boluses. Sedation off. Still cvvhing. Follows commands x 4. Maybe extubate tomorrow? We shall see!

    Mike
  5. 1
    He is now getting iHD, aox3, and asking when he can get out of "here." :-)
    Guttercat likes this.
  6. 0
    Quote from MLB55
    He is now getting iHD, aox3, and asking when he can get out of "here." :-)
    Very cool.
  7. 0
    that's what you take in neuro ICU? I had no idea
    What's his neuro issue?
  8. 0
    No neuro issues. Just a micu overflow! My first time cvvhing, I think it went well as he looked as he was not going to make it out.
  9. 0
    I had a patient the other day who apparently had mulitple AVF that got infected and wouldn't work. He had old ones in both arms, recently had a catheter placed in his right groin but that got infected so they placed one in his left. Needless to say, he was scheduled for a permacath placement that AM.

    My question is since he has old fistulas that are not working or usable in both upper extremities, would it be ok to stick/use those arms? I would say yes since the AVF are not working/there is no use for them.

    Thoughts?
  10. 0
    Yes, that should be fine. I would always clear it with nephrologist first


Top