Life Threatening Vascular Access Hemorrhage Prevention
Statement
Patients with end-stage kidney failure frequently require
hemodialysis, a medical treatment that replaces the function of the kidneys by
filtering blood and removing waste products. The site at which blood is removed
from and returned to the body is called a vascular access site, which is
typically created through a graft, fistula or a central venous catheter.
Vascular access sites are associated with many potential complications,
including infection and blood clotting. Severe hemorrhagic shock or death from
excessive blood loss is one of the most serious and preventable of these
complications. It can occur when a blood vessel graft or AV fistula erodes
through the skin, a false aneurysm develops at the access site, or a central
venous catheter is accidentally cut or dislodged. Use of any vascular access by
untrained individuals for blood sampling, intravenous substance abuse by
dialysis patients, or access site infections are other important factors, which
may result in vascular access failures, potentially fatal hemorrhages or
overwhelming septicemia.
Lethal vascular access related hemorrhagic complications
occur in a very small percentage of hemodialysis patients. According to a recent
study, 24 Maryland residents between 28 and 85 years of age died as a result of
severe and uncontrolled bleeding from vascular access sites between the years
2000 and 2006. Of these patients, 63% were male and 75% were African American.
Some deaths from vascular access hemorrhage may have been
preventable. An essential component of patient care is education, and
hemodialysis patients should have repeated educational sessions concerning the
clinical signs of vascular access site complications, including graft failure,
infection or aneurysm formation. They also need to be clearly instructed that
their vascular access is their dialysis lifeline and should only be used for
treatment purposes by trained personnel for dialysis exclusively.
Furthermore, we recommend that nephrologists, vascular access
surgeons and dialysis centers provide ongoing education on the risks of vascular
access hemorrhage and the warning signs of graft failures. A more comprehensive
policy on life saving measures in the event of severe hemorrhage from a vascular
access site will be developed by the professional dialysis community in
cooperation with the Maryland Kidney Commission.
EXCEL