Adverse Technical Events in Home Hemodialysis

Tennankore, Karthik; D'Gama, Celine; Faratro, Rose; Fung, Stella; Wong, Elizabeth; Chan, Christopher T.

doi:10.1053/j.ajkd.2014.08.013

Cited by 54 publications

(41 citation statements)

References 14 publications

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“…Although rates of colonization with multidrugresistant organisms are unknown in patients undergoing home HD, it is plausible that less frequent contact with health care facilities would result in less frequent colonization and infection. Beyond potential differences in risk for nosocomial infection, HD in the home setting may lead to higher risk for rare but potentially catastrophic AV access-related adverse events (26,27).…”

Section: Discussionmentioning

confidence: 99%

Association of Vascular Access Type with Mortality, Hospitalization, and Transfer to In-Center Hemodialysis in Patients Undergoing Home Hemodialysis

Rivara

Soohoo

Streja

et al. 2016

Clinical Journal of the American Society of Nephrology

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Section: Discussionmentioning

confidence: 99%

Association of Vascular Access Type with Mortality, Hospitalization, and Transfer to In-Center Hemodialysis in Patients Undergoing Home Hemodialysis

Rivara

Soohoo

Streja

et al. 2016

Clinical Journal of the American Society of Nephrology

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“…In a retrospective cohort study of 202 patients on home HD, only six patients had suspected air embolism that occurred during 183,603 dialysis sessions for an overall incidence less than one episode per 30,000 dialysis sessions. These episodes were related to inadequate priming or lack of clamping of the catheter or tubing (31). Another study reported a single case of air embolism during follow-up of 190 patients on home HD (approximately 117,000 HD sessions) for an incidence of less than one episode per 100,000 HD sessions.…”

Section: Air Embolismmentioning

confidence: 99%

Diagnosis, Treatment, and Prevention of Hemodialysis Emergencies

Saha

Allon

2016

CJASN

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Given the high comorbidity in patients on hemodialysis and the complexity of the dialysis treatment, it is remarkable how rarely a life-threatening complication occurs during dialysis. The low rate of dialysis emergencies can be attributed to numerous safety features in modern dialysis machines; meticulous treatment and testing of the dialysate solution to prevent exposure to trace elements, toxins, and pathogens; adherence to detailed treatment protocols; and extensive training of dialysis staff to handle medical emergencies. Most hemodialysis emergencies can be attributed to human error. A smaller number are due to rare idiosyncratic reactions. In this review, we highlight major emergencies that may occur during hemodialysis treatments, describe their pathogenesis, offer measures to minimize them, and provide specific interventions to prevent catastrophic consequences on the rare occasions when such emergencies arise. These emergencies include dialysis disequilibrium syndrome, venous air embolism, hemolysis, venous needle dislodgement, vascular access hemorrhage, major allergic reactions to the dialyzer or treatment medications, and disruption or contamination of the dialysis water system. Finally, we describe root cause analysis after a dialysis emergency has occurred to prevent a future recurrence.

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“…The median score for this question was two out of five (range 0-4.5). Interestingly, those patients that predicted the device would create a lot of additional work tended to report high levels of additional work after use and those that predicted little in the way of additional work reported low additional Red ink triggered alarm and clamp deployment 1 (7) Unable to override clamp (during false alarm) 1 (7) Alarm not loud enough to wake patient 1 (7) work after device use (P = 0.09 for difference between pre and post results). Eleven patients rated the "Instructions for Use" and generally found them to be helpful median score of five out of five (range 2.5-5).…”

Section: Resultsmentioning

confidence: 99%

“…Our group previously described outcomes in 202 patients over 757 patient years of home HD. 7 There was a crude major adverse event rate of 0.038 per 1000 dialysis treatments, the majority of which were needle dislodgements (n = 18). A separate review of two Canadian home HD programs assessed 190 patients over approximately 500 patient years of dialysis.…”

Section: Discussionmentioning

confidence: 99%

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A prototype line clamp for venous access bleeding in hemodialysis: A prospective cohort study

Kennedy

McGrath-Chong

Arustei

et al. 2019

Hemodialysis International

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Introduction: Venous needle dislodgement (or venous port disconnection) during hemodialysis (HD) may lead to catastrophic blood loss, particularly during unsupervised home HD. A prototype venous line clamp was developed for use in conjunction with the Redsense blood loss sensor. We hypothesize that this prototype device will provide additional safety to dialysis without excessive burden. Methods: This was a single‐center, prospective cohort study. Participants kept a log of bleeding, troubleshooting and clamp deployment events, and completed questionnaires before device first use and after device final use. The primary outcome was appropriate device function, evaluated by review of bleeding and clamp deployment events. The secondary outcomes were patient/nursing staff expectations and experience of the device. Findings: Fourteen patients used the device during a combined total of 214 HD treatments. Five participants (36%) had experienced a bleeding or disconnection event prior to study recruitment. All vascular access types were represented. The device was tested during incenter HD (n = 7 patients) and home HD (n = 7 patients). There were eight clamp deployment events, three of which were in the setting of minor bleeding at the venous access site. No other bleeding events were reported. The main troubleshooting issues were related to cumbersome device connections. Participants perceived additional safety with the device (median score 4.25 out of 5; range 1–5). However, the amount of additional work created was variable, and large in some cases (median score 2 out of 5; range 0–4.5). There was no association between HD vintage and device burden (P = 0.55). Discussion: This “proof of concept” study confirmed that a clamp on the venous line, operating in conjunction with a venous access blood detector, is feasible regardless of HD location or vascular access type. The device improved patient safety perception during HD but was burdensome. Design modifications could improve future device iterations.

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Adverse Technical Events in Home Hemodialysis

Cited by 54 publications

References 14 publications

Association of Vascular Access Type with Mortality, Hospitalization, and Transfer to In-Center Hemodialysis in Patients Undergoing Home Hemodialysis

Association of Vascular Access Type with Mortality, Hospitalization, and Transfer to In-Center Hemodialysis in Patients Undergoing Home Hemodialysis

Diagnosis, Treatment, and Prevention of Hemodialysis Emergencies

A prototype line clamp for venous access bleeding in hemodialysis: A prospective cohort study

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