Paciente joven en hemodiálisis con más de veinte accesos vasculares

Abstract

Introduction: The vascular access is a basic pillar in the dialytic treatment of renal patients. The use of catheters has increased in recent years.
Clinical case: 49 year old male who started hemodialysis treatment at 32 years. He presented 7 registered access (average use time: 64 days) until the first transplant and other 15 accesses (average use time: 162 days) and 11 infections by Staphylococcus Epidermidis, until receive the second transplant. He lost the graft 5 days after by massive renal ischemic infarction, returning to hemodialysis with the placement of a central venous catheter tunneled in left femoral, that last to the present day without notable complications, mainly due to the subsequent diagnosis of heterozygous mutation in the factor V Leiden (that causes a hypercoagulability disorder), starting oral anticoagulation with acenocoumarol in his home and intradialytic heparin low molecular weight since that time.
Discussion: After starting the sealed catheter with citrate + heparin sodium (initially it also includes Taurolidina, but it was removed due to intolerance), did not give more infections.
Because of the diagnosis of heterozygous factor V Leiden mutation, we consider the possibility that the previous access failures are due to ignorance of this mutation.
Given the demographic situation in Spain, we highlight the need to expand the multidisciplinary teams and include a protocol of control and monitoring of the tunneled access to reduce their losses and avoid a highly invasive.