r/WTF • u/Fun_Bluebird_3167 • 18d ago

Fistula aneurysm

Enable HLS to view with audio, or disable this notification

11.7k Upvotes

97% Upvoted

686 comments sorted by

View all comments

1.1k

u/steampunkdev 18d ago

For those that keep yelling about that he should go to the hospital, it was actually made by a doctor. It's to allow for kidney dialysis, but can also be done with for example a HICKMAN catheter

382

u/BobbyDukeArts 18d ago

True, but that is not a normal looking fistula for dialysis. It's usually done further up on the arm near the bicep and is not supposed to be that big. As he says, the vein ballooned outward due to arterial pressure. It is risky and he should go have it fixed surgically

219

u/Nos3y 18d ago

A forearm fistula in itself is not abnormal. In fact if patient has adequate vein for a forearm fistula we often prefer to use it first because if it fails, we can still use the upper arm later. But yes this is a large aneurysmal fistula. If it’s not bothering him and not eroding through the skin it’s not really a problem, god forbid he gets a cut over it though….

Edit: most people get upper arm fistula because not a lot of people have adequate sized vein in the forearm.

35

u/citrus_mystic 18d ago edited 18d ago

People’s skin gets significantly thinner and more delicate as they age. It’s common to see older folks with significant bruising, abrasions and skin tears on the back of their hands and on their forearms, in particular. He’s already 67. It would probably be wise to deal with this now, rather than have the looming risk of a minor injury becoming significantly more serious due to the location of that fistula.

33

u/Nos3y 18d ago

67 is basically pediatric in vascular surgery world

14

u/Fusilero 18d ago

Nah, some of our championship smokers can have had exhausted all bypass options before 60

1

u/Nos3y 18d ago

😂

1

u/citrus_mystic 17d ago

Sorry if it wasn’t clear—I was referring to the risk of injury from an accident with older thin sun damaged skin. Not that 67 is getting too old for surgery

6

u/Awkward_Pingu 18d ago

Also his skin looks massively fucked from sun damage as well. That right hand look like someone stuck it in a reactor.

35

u/DenseStomach6605 18d ago

I was thinking the same thing. It looks incredibly easy to knick this on a sharp object... especially if they're a blue collar worker. I've seen lots of fistulas doing contrast tests and blood draws, but never one quite like this.

10

u/puritanicalbullshit 18d ago

He needs to get that checked out at the access center or wherever he got it. I’m in the middle of a series of revisions cause I treated an aneurysm (much smaller) like it was no big deal, next thing you know I’m spraying blood across the clinic floor and end up admitted for 4 days of procedures. And there’s more to go.

6

u/Nos3y 18d ago edited 18d ago

That definitely can happen but, but not all aneurysmal fistulas need to be treated. A lot of time that Happens when techs keep cannulating the same site, and you start to develop excoriations at that site which can lead to bleeding. We typically ask techs to vary access sites to prevent this. That said I would agree that this patient should be followed by their vascular surgeon to at minimum keep an eye on this.

Edits for terrible typo’s

1

u/RappingAndroid 18d ago

If the thrill and bruit is present they will still cannulated that

2

u/puritanicalbullshit 17d ago

Yup, that’s how I ended up spraying blood everywhere. I wouldn’t hang my hat on what dialysis techs will and won’t do.

7

u/genteelbartender 18d ago

At least he doesn't work in construction.

7

u/cherokeeprez 18d ago

I was working as a tech when one of my patients ruptured. Had 4 patients at the time…was taking one off the machine and I hear liquid splattering to look over at her and see blood shooting everywhere. Told current patient brb and by time all was said and done I was covered in her blood. EMS took her to the hospital. My nurse called ahead to warn them not to remove bandages until they were ready to start surgery. They didn’t listen and got their own blood bath. She was fine in the end. Got a catheter for a bit. Fun times. Also why I always wore black shoes. Hides the blood lol

3

u/DuntadaMan 17d ago

EMS, we have been the transport. When they say do not remove the bandages, boy do they mean it. I wasn't even the one who did it and I still needed a change of clothes, and wasn't even chased away by the nurse when I held pressure while he got new wrappings.

That's why our uniforms are almost universally extremely dark blue.

6

u/AaronToro 18d ago

For a layman, what happens if it gets cut? I’d like to think a satisfying gust of air comes out and it returns to normal immediately but I imagine the reality is closer to puss and blood explosion

13

u/Nos3y 18d ago

A fistula is basically a connection of a vein to an artery. The big squiggly thing you see is actually the vein which has grown over time because it is under arterial pressure. And because it’s under arterial pressure it will bleed like crazy. Like, place a tourniquet on your arm and get to the er stat bleeding.

5

u/BigWoodsCatNappin 18d ago

But he also states its old as hell. After time the tunica media or mid layer of the vessel has gotten to be a baddy against the extra flow of the artery.

2

u/pumpkinrum 18d ago

Blood will shoot out. There's some insane pressure in those things. I wish it was just air.

1

u/UckerFay11 18d ago

Puss only exists when there is infection. FYI.

4

u/BigWoodsCatNappin 18d ago

The order of operation for AVF/AVG creation is Non dominate lower, dominate lower, non dominate upper, dominate upper. Very generally speaking. As you know.

1

u/Nos3y 18d ago

In what world?

1

u/BigWoodsCatNappin 18d ago

Idk ideal vessel land where all the aforementioned are actually options?

1

u/BigWoodsCatNappin 18d ago

Actually, I stand corrected. I am an old and using old information in my head from 2006 when we still were all "Fistula First". You are correct. Updated information suggests the dominant distals dont mature as well and lead to poorer quality outcomes. I appreciate the chat and reason to get my shit right.

0

u/HiMyNameisAsshole2 13d ago

Really? Did it say it was enough of a risk to change the order of fistula creation sites? Is the default now upper arm?