WANDERING EDEMA, CENTRAL VENOUS CATHETERISM AND GUIDELINES

 

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by Davide Rossi, Daniela Ricciardi, Ketty Savino* and Riccardo M. Fagugli
Nephrology and Dialysis Department, Silvestrini Hospital, Perugia, Italy
* Cardiology and cardiovascular pathophysiology, Silvestrini Hospital, Perugia, Italy



Corresponding author:
Davide Rossi, MD
S.C. Nefrologia e Dialisi
Ospedale Silvestrini
Azienda Ospedaliera di Perugia
S.Andrea delle Fratte
06100 Perugia, Italy
Tel: +39 0755782268
Fax: +39 0755782558
E- mail: rossidav72@virgilio.it

 

Case Report:
A 80-year-old Caucasian female, with a past medical history of chronic kidney failure, diffuse atherosclerosis, multiple myeloma and breast cancer surgically treated, was admitted to the hospital because of remarkable volume overload and worsening renal function within three months. On examination, there was lower limbs edema and a characteristic wandering edema of the arms and of the upper trunk; a grade 2-3/6 cardiac systolic ejection murmur was present. The laboratory tests revealed the presence of severe kidney failure and her 24 h urine volume was below 300 ml, although high diuretics dose. The patient denied to have taken potential neprhotoxic drugs (i.e. NSADs), the urine colture was negative and the renal ultrasound showed no hydronephrosis and a significant length reduction of both kidneys.






In consideration of the presence of fluid retention and severe kidney failure, hemodialysis treatment was begun, after the insertion of a venous catheter as temporary vascular access.

Question 1) - According to the NKF-K/DOQI Guidelines 2000, which insertion site for temporary vascular access should not be used in a patient with end-stage renal disease?
(Only ONE answer is correct)
a) subclavian vein
b) internal jugular vein
c) femoral vein