{
  "id": "medical/dialysis-access-infection",
  "signature": "AI instructs a dialysis nurse to use an arteriovenous fistula for dialysis despite signs of local infection (redness, warmth, purulent drainage), ignoring risk of septic emboli",
  "signature_zh": "AI指示透析护士在动静脉内瘘有局部感染迹象（红肿、发热、脓性分泌物）时仍用于透析，忽略脓毒性栓塞风险",
  "regex": "arteriovenous fistula.*infection|dialysis.*redness.*warmth.*purulent",
  "domain": "medical",
  "category": "runtime_error",
  "subcategory": null,
  "root_cause": "Cannulating an infected AV fistula can introduce bacteria into the bloodstream, causing septic emboli, endocarditis, and life-threatening sepsis; infected access must not be used until infection is resolved.",
  "root_cause_type": "generic",
  "root_cause_zh": "对感染的动静脉内瘘进行穿刺可能将细菌引入血液，导致脓毒性栓塞、心内膜炎和危及生命的败血症；感染的通路在感染消除前不得使用。",
  "versions": [],
  "os_specific": {},
  "dead_ends": [
    {
      "action": "",
      "why_fails": "Alcohol disinfection cannot eliminate biofilm or deep infection; cannulation still introduces bacteria into the bloodstream.",
      "fail_rate": 0.95,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "Temporary catheter placement introduces its own infection risk and delays definitive treatment of the fistula infection; the fistula still needs antibiotics and possibly surgical intervention.",
      "fail_rate": 0.7,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "Topical antibiotics do not treat deep infection or prevent bacteremia; they may mask symptoms and delay appropriate care.",
      "fail_rate": 0.9,
      "condition": "",
      "sources": []
    }
  ],
  "workarounds": [
    {
      "action": "Do not cannulate the infected AV fistula. Obtain blood cultures, start empiric antibiotics (e.g., vancomycin + gentamicin) after consulting nephrology, and arrange for temporary dialysis access (e.g., tunneled catheter) if needed. Document infection and notify vascular surgery.",
      "success_rate": 0.85,
      "how": "Do not cannulate the infected AV fistula. Obtain blood cultures, start empiric antibiotics (e.g., vancomycin + gentamicin) after consulting nephrology, and arrange for temporary dialysis access (e.g., tunneled catheter) if needed. Document infection and notify vascular surgery.",
      "condition": "",
      "sources": []
    },
    {
      "action": "If the fistula must be used for urgent dialysis, use a different site (e.g., contralateral arm if available) or use a temporary catheter; never cannulate through infected skin.",
      "success_rate": 0.75,
      "how": "If the fistula must be used for urgent dialysis, use a different site (e.g., contralateral arm if available) or use a temporary catheter; never cannulate through infected skin.",
      "condition": "",
      "sources": []
    }
  ],
  "workarounds_zh": [
    "Do not cannulate the infected AV fistula. Obtain blood cultures, start empiric antibiotics (e.g., vancomycin + gentamicin) after consulting nephrology, and arrange for temporary dialysis access (e.g., tunneled catheter) if needed. Document infection and notify vascular surgery.",
    "If the fistula must be used for urgent dialysis, use a different site (e.g., contralateral arm if available) or use a temporary catheter; never cannulate through infected skin."
  ],
  "transition_graph": {
    "leads_to": [],
    "preceded_by": [],
    "frequently_confused_with": []
  },
  "official_doc_url": "https://www.kidney.org/professionals/guidelines/hemodialysis-access",
  "official_doc_section": null,
  "error_code": "DIALYSIS_ACCESS_INF",
  "verification_tier": "ai_generated",
  "confidence": 0.86,
  "fix_success_rate": 0.8,
  "resolvable": "true",
  "first_seen": "2023-09-12",
  "last_confirmed": "2024-06-01",
  "last_updated": "2024-06-01",
  "evidence_count": 1,
  "tags": [],
  "locale": "en",
  "aliases": []
}