Case report

Brachio-cephalic ('Gracz') fistula use for continuous hemofiltration in a hemodynamically unstable hemodialysis patient without venous vascular access: a case report

Peter E Spronk^1,2,4 , Jos NM Barendregt³ , Guus Crooijmans³ , Yolande M Vermeeren³ and Johannes H Rommes¹

¹  Department of Intensive Care Medicine, Gelre Hospitals, Apeldoorn, The Netherlands

²  Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, The Netherlands

³  Department of Internal Medicine, Gelre Hospitals, Apeldoorn, The Netherlands

⁴  Hermes critical care group, Amsterdam, The Netherlands

author email corresponding author email

Journal of Medical Case Reports 2007, 1:39doi:10.1186/1752-1947-1-39

Published:	30 June 2007

Abstract

Even in patients with chronic renal failure and chronic intermittent hemodialysis, continuous venovenous hemofiltration (CVVH) is the most often practiced renal replacement technique in the intensive care unit. Although patients show less hemodynamic instability during CVVH than during hemodialysis, it requires a blood flow exceeding 200 ml/min in the extracorporeal circuit necessitating the use of large bore catheters. Vascular access in critically ill septic and edematous patients is sometimes difficult, or even impossible.

We describe a technique of using a brachio-cephalic arterio-venous fistula in a hemodialysis patient for continuous hemofiltration (HF) resulting in improved hemodynamic stability.