Your Blood is Filtered During Dialysis
If you have endstage kidney disease, you may require dialysis. This is the most common treatment for patients with kidney failure. During dialysis, your blood is filtered through an artificial kidney, or dialysis machine, where waste products can be eliminated. Patients who are undergoing hemodialysis usually have treatment three times each week, so they need a reliable vascular access.
There Are Different Types of Dialysis Access
There are several types of vascular access for dialysis and they are usually created in the patient’s arm. An AV (arteriovenous) fistula is a connection formed surgically between an artery and a vein. Arteries carry oxygenated blood away from the heart under high pressure, so they have thicker walls than veins, which return blood from the body’s tissues to the heart for oxygenation. An AV fistula allows the vein to become thicker and less likely to collapse when it is punctured regularly for dialysis treatment. This type of
Some patients are not good candidates for a fistula and may require another type of vascular access, known as an arteriovenous (AV) graft. This refers to artificial tubing attached to an artery at one end and a vein on the other. The tubing is placed under the skin and during dialysis, the tubing is punctured instead of the blood vessel. AV grafts are more likely to clot or become infected compared to fistulas. They usually last two or three years.
Temporary dialysis access can be obtained through a plastic tube, or catheter, inserted into a large vein, like the jugular vein in the neck. There is also a device that is a hybrid of an AV graft and a venous catheter, which is designed for patients with narrow veins that might prevent other devices from working properly.
Known Complications Associated with Vascular Dialysis Access
There are a variety of complications that can occur in patients undergoing dialysis. These include infection, clotting, and bleeding. These complications are not unusual and cannot always be prevented.
An arteriovenous fistula may bleed if it is not allowed to “mature” over an adequate period of time. It usually takes three to six months for an arteriovenous fistula to mature enough to be safely used for hemodialysis. Some fistulas may take a year to mature. If an arteriovenous fistula has not matured, another type of access should be used until maturation is complete. A bleed can occur after routine dialysis or after trauma to the access site. Bleeding may complicate recovery after initial placement of the access.
Blood vessels and grafts used for dialysis can also become stenotic, or narrowed, which increases the risk of clot formation. Failure to treat a stenotic graft can result in excess blood and distension of the blood vessel in the area next to the narrowed portion., increasing the risk of rupture. A stenotic or clotted graft can also become permanently damaged and will require another surgical procedure for replacement.
Clotted vascular access sites are a cause of frequent emergency department visits by patients who require dialysis. If they are promptly recognized, they can sometimes be treated by removal of the clot or buy injection of a “clot-dissolving” drug directly into the clot.
Aneurysms, or weak spots in the wall of a fistula or graft, can occur over time. These are a potential risk for hemorrhage and should be corrected to prevent rupture. Of 24 vascular access hemorrhage fatalities in Maryland, 22 ruptures occurred while the patients were away from the dialysis facility. Many occurred in assisted living or nursing homes. Some of these deaths were preventable, a finding that highlights the importance of monitoring the vascular access used for dialysis.
Fatal vascular access hemorrhages account for 0.4% of dialysis deaths, but are sometimes avoidable. When patients are undergoing dialysis at a dialysis center, the nurses and technicians have a duty to monitor the access site during treatment. Most facilities have policies that prevent patients from covering the access site with a coat or blanket, but these policies are sometimes ignored.
Excessive heparin dosages during dialysis can cause fatal bleeding.
In addition to routine complications of hemodialysis, errors in treatment can result in death. Hemorrhages from a dialysis access site usually result when the anastomosis, or connection, ruptures, or in the setting of excess heparin administration.
People with kidney disease have abnormal bleeding times because their platelets don’t function properly, so they are already at increased risk of hemorrhage. This risk is increased during hemodialysis, because patients receive an anticoagulant like heparin, to prevent clot formation. If the dialysis technician administers too much heparin, the patient is at high risk of hemorrhage until the medication is eliminated or treated with a reversal agent. Unfortunately, a heparin overdose may be recognized until it is too late.
Fatalities resulting from dislodged needles
Death or significant blood loss requiring transfusion occurs when a needle dislodges during dialysis. The blood flowing into the dialysis machine is under pressure, so any breach in the dialysis circuit will result in rapid blood loss. Unfortunately, this preventable occurrence occurs too frequently. If the bleeding is not controlled rapidly, then it may result in the need for transfusion, which carries significant risks. Even worse, the rapid rate of blood loss from a dislodged dialysis needle can cause death if not recognized by medical personnel at the facility. Government investigation of these incidents found a failure to adhere to minimum standards of care at facilities where these events resulted in patient injury or death.
Contact us today for an evaluation of your dialysis injury.
If you or a loved one has experienced injury or death from bleeding associated with dialysis, call us today for a review of your case. If you have been the victim of medical malpractice or negligence, you may be entitled to restitution.