Serious injury or illness may occur if care is not taken during connection of the hemodialysis catheter. The CDC guidelines are quite clear. They include ensuring that staff dealing with hemodialysis patients are competent at their tasks, and the CDC recommends assessment each year and at hiring for hemodialysis staff.
Primary causes for concern include hygienic techniques. Specifically, staff should know how to appropriately wash their hands, and when to use gloves. Catheter dressing change should include hand washing, use of gloves, and use of antiseptics. When vascular access is obtained, the same hygiene rules should be observed, and the port or point of vascular access should be cleaned with antiseptics and aseptic technique employed.
Staff should understand how to correctly prepare medications, which will be injected into the bloodstream. Infections frequently occur in dialysis patients, because they have weakened immune systems.
Many unfortunate incidents occur as a result of incorrect connection of the dialysis catheter. These incidents include heavy bleeding and air embolism, both of which can be deadly. Sadly, small errors may result in irreversible consequences for patients.
A dislodged venous fistula catheter during dialysis can lead to significant blood loss. The VA alone reported 40 fatalities as a result of bleeding, after a study of bleeding incidents during dialysis from 2002 through 2008. Risk factors for insecure attachment of the venous catheter include restless or agitated patients, confused patients or those who were asleep. 50% of the fatal incidents reported at the VA occurred outside of the dialysis unit, either in patient rooms or in the ICU.
Normally, there is an alarm that records venous pressure on the dialysis machine. In most of these fatal cases, the alarms failed to either detect the low pressure or failed to alert the nursing station.
The results of the VA study led to recommendations that the venous access site always be visible. This included the recommendation that patients be observed continuously during dialysis, with the recognition that alarms may not always be dependable.
HemaClip patient connector clips are widely available, and should be utilized under most conditions. Interestingly, at the time of the study, Fresenius, a large supplier of hemodialysis equipment, had only evaluated their HemaClip with their own Combiset dialysis tubing, and would not sell to facilities that do not use the Combiset tubing. Fresenius is currently facing lawsuits from other dialysis equipment and dialysate materials.
Taping techniques are not standardized, and this would probably be an aid to prevention of dislodgement of venous access devices. Redsense has developed an alarm designed to detect dislodgment of venous catheters. However, nurses should be universally aware that devices are not failsafe, and the best practice involves direct observation of the patient undergoing dialysis, with the dialysis site in view.
Other significant causes of morbidity and mortality during dialysis include pulmonary embolism resulting from attempts to unblock an arteriovenous fistula, air embolism as a result of catheter dislodgement, bleeding from infected catheter sites, infection, and medication errors involving the intravenous administration of potassium. Although most patients undergo dialysis safely, untrained or busy healthcare providers may not adequately protect patients undergoing dialysis.
If you have experienced injury or infection as a result of unsafe or substandard dialysis procedures, you may want to consult a personal injury attorney to evaluate your case.
