A 71-year-old man, who had been on hemodialysis therapy for 15 years, began experiencing repeated swelling, erythema, and pruritus around his arteriovenous fistula (AVF) during the last three years. He received 5 hours of hemodialysis using a polysulfone membrane three times weekly. The AVF, located in his left forearm, was accessed using a 16-gauge hemodialysis cannula. A lidocaine patch was used to alleviate pain associated with accessing the AVF. Before inserting the cannula, the site was cleaned with an antiseptic swab containing chlorhexidine.
Since it was difficult to cannulate the AVF because of the ongoing erythema and edema of his forearm, a new AVF was created in the opposite forearm. Approximately a week after initiating cannulation of the new AVF, the patient again developed edema and erythema of the arm. In all other aspects, the patient was well. What are the potential…
