Female 52 with past medical history of DM, HTN, IHD, ESRD has right Brachio-Basilic AVF superficialisation for 2 years
Presented with localised swelling, redness and tenderness with no discharge
USS shows Localised haematoma no raised inflammatory markers
What would be your management plan please
Rest of fistula and insertion of temporary catheter
Start ABx, anti inflammatory and close monitoring
Q1. Rest of fistula and insertion of mahockar
Start ABx, anti inflammatory and close monitoring
Good, for antibiotics I would be driven by inflammatory markers and clinical signs of sepsis
It depends on where exactly is hematoma, if it is in part of the vein so i will recommend to spare this part from cannulation, 5 days of ABx and follow up. if it is affecting the whole length, I will recommend to rest the fistula and insert a temporary line for a while.
I will also try to chase what was the cause of this hematoma, deep fistula, outflow stenosis, infection, coagulopathy or something else.
Very good, just for antibiotic I would be driven by inflammatory markers and clinical signs of sepsis
What would be your management plan
I will start imperical antibiotic ask for limb elevation , anti edematous measures , insertion of central line to rest the fistula follow up dupplex to detect if the hematoma is increasing in size or decreased flow inside the fistula for possible surgical intervention
Very good
Conservative antiedematous antiinflamatory antibiotic hot fomentation rest of fistula for to weeks
Thanks , very good answer….for antibiotic I would be driven by inflammatory markers and clinical signs of sepsis