Hemorrhagic Shock due to Cutting of the Tunneled Dialysis Catheter
Bibliographic record
Abstract
Introduction: Bleeding is a relatively rare complication of dialysis CVC overall. Case Description: We describe the case of a 68-year-old non English speaking dementia patient with ESRD on HD. While in hospital, he had tried to cut the tape that was causing itching, but accidentally cut CVC. He was found in shock, bleeding from the exit site, which required aggressive resuscitation and compression to stop bleeding. After stabilisation examination revealed a palpable, well retracted catheter that was not visible (Fig 1). X ray showed the catheter in situ, but the Y along with the arterial and venous ports were absent (Fig 2). In retrospect, bleeding was particularly difficult to control because the cuff at this location is rigid and not compressible. This places the patient at increased risk for exsanguination leading to hemorrhagic shock, air embolism and mortality. Discussion: To our knowledge, this is the first report of a cut tunnelled CVC proximal to the Y. This case demonstrates the risk of significant hemorrhage when a tunnelled CVC is damaged at this location and need for early recognition and control of bleeding. It also highlights important patient safety considerations given the risk of self-inflicted trauma in patients with dementia and language barrier for communication.Catheter palpable, but not seen.X Ray showing the retained tunnelled catheter proximal to Y
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".