Clin Nephrol
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Sepsis as a consequence of central venous hemodialysis catheter colonization is a major cause of morbidity in the hemodialysis population. We have previously shown that the majority of catheters become colonized and that this is associated with peripheral bacteremia. The time period over which this colonization occurs is unknown. ⋯ Bacterial colonization of central venous catheters often leads to bacteremia. The time between insertion and colonization is very variable, but is universally present after 16 weeks. The risk of subsequent bacteremia is related not only to time left in situ, but also the degree of colonization. Surveillance cultures would allow clinicians to detect colonization before bacteremia occurs and take preventative measures.
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Comparative Study
Insertion of internal jugular temporary hemodialysis cannulae by direct ultrasound guidance--a prospective comparison of experienced and inexperienced operators.
Previous studies have shown that inexperienced operators have a lower success rate than experienced operators for insertion of internal jugular cannulae using the anatomical landmark technique. The object of this study was to determine the rate of successful insertion, incidence of immediate complications and incidence of infection for temporary hemodialysis cannulae inserted under ultrasound guidance by experienced and inexperienced operators. ⋯ We conclude that ultrasound guided temporary haemodialysis cannulation is a safe procedure with a high rate of success, the success rate for inexperienced operators is much higher than previous studies of cannulation using the anatomical landmark technique and the rate of cannula removal due to infection is not influenced by operator experience.
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Two male patients with chronic renal failure maintained on hemodialysis developed progressive clinical features of ischemic necrosis (so called calciphylaxis) of their extremities and penis. Both patients died. ⋯ A role of iron overload on the production of calciphylaxis is reviewed. This report is perhaps the first in nephrology literature on the occurrence of calciphylaxis involving penis and prepuce.