Abstract: FR-PO543
Beyond Appearances: A Case Report of Mistaken Identity in Dialysis Access
Session Information
- Dialysis Vascular Access
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 803 Dialysis: Vascular Access
Authors
- Demie, Ephrem Digafie, HCA Healthcare Inc, Nashville, Tennessee, United States
- Owji, Shahin Cyrus, HCA Healthcare Graduate Medical Education, Brentwood, Tennessee, United States
- Shafiq, Mohammad, HCA Healthcare Graduate Medical Education, Brentwood, Tennessee, United States
- Raayasa, Srikanth Krishnamurthy, HCA Healthcare Graduate Medical Education, Brentwood, Tennessee, United States
Group or Team Name
- HCA Nephrology Team.
Introduction
In this case report, we present a remarkable case involving a patient with a transhepatic hemodialysis (HD) catheter. The transhepatic hemodialysis catheter involves placing a catheter through the right or middle hepatic veins when other options have been exhausted. The catheter became dislodged into the peritoneal cavity and was subsequently mistaken for a peritoneal dialysis catheter.
Case Description
A 34-year-old female with a history of lupus, hypertension, and end-stage renal disease on hemodialysis presented to the ER with concerns about a malfunctioning hemodialysis catheter for a week. During her ER visit, an initial x-ray revealed a percutaneous catheter in the right abdomen. A CT scan of the abdomen and pelvis showed a dislodged transhepatic hemodialysis catheter, misinterpreted as a peritoneal dialysis catheter, leading to a delay in treating the potential causes of the patient's symptoms. Both the ER physician and the hospitalist failed to promptly diagnose the issue, resulting in the patient not receiving timely appropriate surgical intervention and renal replacement treatment.
Discussion
Catheters utilized for hemodialysis access, such as transhepatic access, exhibit varying radiographic appearances, yet share common features of large bore catheters with a double lumen. A properly positioned transhepatic hemodialysis catheter traverses subcutaneously through the liver parenchyma, hepatic vein, and inferior vena cava before terminating within the right atrium. However, transhepatic catheters are susceptible to migration, often evidenced by imaging depicting the catheter tip retrogressing into the hepatic vein or descending into the peritoneal cavity. This can lead to delays in diagnosis and management, as was evident in this case.
CT scan showing the Transhepatic HD catheter