Clinical Case Scenario 1
A 65-year-old, female (Weight: 70 kg, Height: 160 cm), with a previous medical history of end-stage renal disease (ESRD) on hemodialysis, essential hypertension, diabetes mellitus type 2, peripheral vascular disease admitted to the ICU with acute pulmonary oedema secondary to fluid overload. On day one, she presented with shortness of breath, orthopnoea, and bilateral lower extremity oedema.
Her vitals are as follows- Blood Pressure: 170/95 mmHg; Heart Rate: 100 bpm; Respiratory Rate: 28 breaths/min; Oxygen Saturation: 88% on room air, which improved to 95% on 5 L/min nasal cannula.
Her laboratory investigations are:
Hemoglobin: 10.5 g/dL
WBC: 11,000 /µL
Platelets: 140,000 /µL
Serum Creatinine: 8.2 mg/dL
Blood Urea Nitrogen (BUN): 90 mg/dL
Potassium: 6.2 mEq/L
BNP: 1500 pg/mL
Arterial Blood Gas (ABG) values are as follows-- pH 7.30, PaCO2 : 50 mmHg, PaO2 : 65 mmHg, HCO3 : 24 mEq/L
A Chest X-ray showed bilateral pulmonary infiltrates consistent with pulmonary edema.
Emergency hemodialysis was planned, and a dialysis catheter insertion was scheduled as the patient does not have a functioning arteriovenous fistula.
Which of the following factors has the greatest impact on the flow rate of a dialysis catheter and which site should be selected (considering all available sites)?
