Fatal exsanguination from hemodialysis vascular access sites

Gill, James R.; Storck, Kara; Kelly, Seán

doi:10.1007/s12024-011-9303-0

Cited by 36 publications

(34 citation statements)

References 15 publications

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“…Hemorrhage from an AV access is an uncommon but potentially fatal complication if it is not recognized promptly and acted on with an appropriate intervention. Most fatal vascular access hemorrhages occur outside of the dialysis facility, but occasionally, they rupture at the dialysis unit (120). Patients and their families should be educated about the recognition and emergent management of a bleeding AV access.…”

Section: Vascular Access Hemorrhagementioning

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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Section: Vascular Access Hemorrhagementioning

confidence: 99%

Diagnosis, Treatment, and Prevention of Hemodialysis Emergencies

Saha

Allon

2016

CJASN

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“…Hemorrhage from fistula has been reported in the in-center HD population, 38,39 but the incidence of this occurring among home patients is unknown. All patients should be instructed to apply pressure to their site in the event of bleeding and to call for emergency assistance (e.g., 911, 991, 999, 112, or 000 as appropriate).…”

Section: Fistula Hemorrhagementioning

confidence: 99%

“…In general, donning clean gloves and mask are a requirement when accessing the catheter. 39 Locking. After dialysis, catheters are most commonly locked with citrate 4% and heparin at a concentration of 1000 or 5000 U/mL; however, the following should be considered in selecting a lock solution:…”

Section: Catheter Care Protocolsmentioning

confidence: 99%

The care and keeping of vascular access for home hemodialysis patients

Faratro

Jeffries

Nesrallah

et al. 2015

Hemodialysis International

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Creating and maintaining a healthy vascular access is a critical factor in successful home hemodialysis (HD). This article aims to serve as a "how-to manual" regarding vascular access issues for both patients and health-care providers in a home HD program. This document outlines cannulation options for patients with arteriovenous access and describes troubleshooting techniques for potential complications; strategies are suggested to help patients overcome fear of cannulation and address problems associated with difficult cannulation. Technical aspects of central venous catheter care, as well as a guide to troubleshooting catheter complications, are covered in detail. Monitoring for access-related complications of stenosis, infection, and thrombosis is a key part of every home HD program. Key performance and quality indicators are important mechanisms to ensure patient safety in home HD and should be used during routine clinic visits.

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“…Vascular access bleeding is brisk and can be catastrophic within a short time. A review of the New York City Office of Chief Medical Examiner death certificates over an 8‐year period identified 100 deaths due to hemorrhage from an AV fistula or graft . Although specific details regarding the bleeding sites and events were not given, the rapidity of death in this context was apparent with most patients dying at home (44%) or on the way to hospital (37%).…”

Section: Discussionmentioning

confidence: 99%

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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Fatal exsanguination from hemodialysis vascular access sites

Cited by 36 publications

References 15 publications

Diagnosis, Treatment, and Prevention of Hemodialysis Emergencies

Diagnosis, Treatment, and Prevention of Hemodialysis Emergencies

The care and keeping of vascular access for home hemodialysis patients

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

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