Repeated Neurological Complications during Dialysis – A Case for Echo?

Authors

  • Danja S. Groves M.D., Ph.D.,

    Corresponding author
    1. Department of Anesthesiology and Intensive Care Medicine, University of Muenster, Muenster, Germany
    2. Departments of Anesthesiology, University of Virginia, Charlottesville, Virginia
    • Address for correspondence and reprint requests: Danja S. Groves, M.D., Ph.D., Department of Anesthesiology, University of Virginia, P.O. Box 800710, Charlottesville, VA 22908-0710. Fax: 434-982-0019; E-mail: dgroves@virginia.edu

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  • Ulf Harding M.D.,

    1. Department of Anesthesiology and Intensive Care Medicine, University of Muenster, Muenster, Germany
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  • Christian Lanckohr M.D.,

    1. Department of Anesthesiology and Intensive Care Medicine, University of Muenster, Muenster, Germany
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  • Antje Gottschalk M.D.,

    1. Department of Anesthesiology and Intensive Care Medicine, University of Muenster, Muenster, Germany
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  • John A. Kern M.D.,,

    1. Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia
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  • Christoph Schmidt M.D., Ph.D.

    1. Department of Anesthesiology and Intensive Care Medicine, University of Muenster, Muenster, Germany
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  • The authors declare that they sought and received written permission from the patients relative to report the case.

Mini-Abstract

A 65-year old woman presented with acute or chronic renal failure and signs of right heart failure. Renal replacement therapy—using a surgically placed dialysis catheter via the left jugular vein—was repeatedly complicated by altered flows of the dialysis unit, impaired consciousness, new onset of seizures and left-sided hemiparesis. The tip of the dialysis catheter was detected on transesophageal echocardiography within the lumen of the ascending aorta. Further imaging of the neck vessels demonstrated a primary placement of the catheter in the left common carotid artery. This incident underscores the value of ultrasound guidance for placement of intravascular catheters.

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