Pherwani AD
United Kingdom
Case Report
Dual Use of an Arterio-Venous Fistula for Total Parentral Nutrition and Haemodialysis: Potential and Pitfalls
Author(s): Kirby GC, Meecham L, Evans RPT, Wessels J, Asquith JR, Leslie FM, Macano CAW, Nyasavajjala SM and Pherwani ADKirby GC, Meecham L, Evans RPT, Wessels J, Asquith JR, Leslie FM, Macano CAW, Nyasavajjala SM and Pherwani AD
Introduction: We present the dual use of an arteriovenous fistula (AVF) for contemporaneous administration of home parenteral nutrition (PN), and hemodialysis (HD). Case Report: A 52 year old female patient required PN due to short bowel syndrome, following extensive resection for ischemic bowel. After she was rendered dialysis dependent secondary to multifactorial renal failure, a left forearm basilica vein transposition onto the radial artery was undertaken. Venous access for PN was problematic. We commenced home PN via the AVF, using a ‘buttonhole’ technique to cannulate the fistula for both HD and PN. The peripheral administration of PN necessitated reduction in the osmolality, with larger volumes and longer administration times. This required adjustment of the HD regime to compensate.The patient received simultaneous PN and HD at home through the AVF successfully for .. View More»
