# 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

- **ID:** `medical/dialysis-access-infection`
- **Domain:** medical
- **Category:** runtime_error
- **Error Code:** `DIALYSIS_ACCESS_INF`
- **Verification:** ai_generated
- **Fix Rate:** 80%

## 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.

## Workarounds

1. **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.** (85% success)
   ```
   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.
   ```
2. **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.** (75% success)
   ```
   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.
   ```

## Dead Ends

- **** — Alcohol disinfection cannot eliminate biofilm or deep infection; cannulation still introduces bacteria into the bloodstream. (95% fail)
- **** — 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. (70% fail)
- **** — Topical antibiotics do not treat deep infection or prevent bacteremia; they may mask symptoms and delay appropriate care. (90% fail)