Venous Needle Dislodgement – A Universal Concern
Abstract
Venous needle dislodgement is a potentially life-threatening complication of dialysis that can happen to anyone in any dialysis setting throughout the world. This article considers all aspects of venous needle dislodgement, from risk factors to prevention. Careful adherence to established policies and procedures, as well as use of a blood loss detection device such as Redsense (Redsense Medical AB, Halmstad), may decrease the likelihood of this serious complication.Support: The publication of this article was funded by Redsense Medical. The views and opinions expressed are those of the author and not necessarily those of Redsense Medical.
Dialysis, haemodialysis, venous needle dislodgement, death, complications, vascular access, haemorrhage, exsanguination, needle, blood loss detector
The safety of healthcare in the US has been placed under a microscope. Concerns in every area of medicine have triggered enquiries into the relationship between patient safety and patient outcomes. It is recognised that patient safety is a national healthcare issue that deserves a concerted effort to reduce system failures and medical errors that lead to adverse events and preventable injuries and deaths. The US is not alone in its efforts to improve patient care. The European Network for Patient Safety and the American National Patient Safety Foundation are both in the business of promoting patient safety.
In the past 65 years, we have witnessed many amazing advances in medicine. Diseases that would have been fatal in 1945 are now usually treatable and many are curable. More and more advances are made every day. Haemodialysis remains one of the most complex medical procedures available to patients, requiring a team of highly trained professionals who are responsible for delivering safe and effective care to the patient.
Patient safety issues in dialysis are a global concern. Dialysis patient safety is a complex issue that involves consideration of the following factors:1
- highly specialised dialysis technology;
- staff training and turnover;
- cost pressures;
- reporting of problems;
- oversight and regulations;
- water purification;
- dialyser re-use;
- medication errors;
- patient compliance;
- patient education;
- prevention;
- vascular access;
- infection;
- location and layout of dialysis units; and
- increased age and co-morbidities of the dialysis population.
One issue in particular, venous needle dislodgement (VND), may occur any time haemodialysis is administered through a fistula or graft access. The newest figures available from the US indicate that VND is a much larger problem than once believed.2–3
Complications of Dialysis
Every medical procedure carries a certain amount of risk and subsequent complications. Some complications are minor, requiring little or no intervention, while others may cause permanent disability and even death.
Complications associated with dialysis may arise from machine malfunctions, poor design, defective products, adverse reactions to medications, alteration in the patient’s level of consciousness/condition and human error/inattention. Dialysis professionals are constantly alert for possible complications that may occur as a result of the treatment before, during and after dialysis. Because dialysis affects every system in the body, the list of potential complications is long. Some examples are:
- decreased blood pressure;
- cramps;
- increased temperature;
- heart irregularities;
- air embolism;
- infections;
- seizures;
- low oxygen level;
- VND.
- ESRD Patient Safety Initiative, available at: www.kidneypatientsafety.org/about.aspx (accessed 27 September 2011).
- 2007 RPA patient survey, available at: www.kidneypatientsafety.org/uploadedFiles/HSS%20Patient% 20Survey%20Report_FNL_3-21-07.pdf?n=448 (accessed 27 September 2011).
- 2008 Veterans Administration Patient Safety Advisory: Bleeding Episodes During Dialysis, available at: www.patientsafety.gov/alerts.html (accessed 27 September 2011).
- Sandroni S. Catastrophic Hemorrhage from Venous Needle Dislodgement during hemodialysis: An unresolved risk of catastrophic hemorrhage, available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1492- 7535.2005.1121cl.x/abstract (accessed 27 September 2011).
- www.enotes.com/science-fact-finder/human-body/howmuch- blood-average-human-body (accessed 13 May 2011).
- Kolecki P, Menckhoff CR, Hypovolemic shock, Medscape Reference: Drugs, Diseases and Procedures, Updated 11 March 2010. Available at: http://emedicine.medscape.com/ article/760145-overview (accessed 13 May, 2011).
- Moses, Scott, Hemorrhage Evaluation, Family Practice Notebook, 2011. Available at: www.fpnotebook.com/ER/FEN/HmrhgEvltn.htm (accessed 27 September 2011).
- Roy T, Patients’ safety and haemodialysis devices, Nephrol Dial Transplant, 2001;16:2138–42.
- Graham K, Cvach M, Monitor alarm fatigue: standardizing use of physiological monitors and decreasing nuisance alarms, Am J Crit Care, 2010;19:28–34.
- Sofocleous C, Cerveira J, Cooper SG, Yudd M, Dialysis fistulas, Medscape Reference: Drugs, Diseases and Procedures, Updated 29 March 2011. Available at: http://emedicine.medscape.com/article/ 419393-overview (accessed 13 May 2011).
- Undetected venous line dislodgment during hemodialysis, Health Devices, 1998;27:404–6.
- Van Waeleghem JP, Chamney M, Lindley EJ, Pancírová J, Venous needle dislodgement: how to minimise the risks, J Ren Care, 2008;34:163–8.
- 2008 Veterans Administration Patient Safety Advisory Bleeding Episodes During Dialysis, available at: www.patientsafety.gov/alerts.html (accessed 27 September 2011).
- Sandroni S, et al, Catastrophic hemorrhage from venous needle dislodgement during hemodialysis, J Am Soc Nephrol, 2008:19, Pub 345.
- Renal physicians association, US, patient survey 2007. Available at: www.kidneypatientsafety.org/uploadedFiles/ HSS%20Patient%20Survey%20Report_FNL_3-21-07.pdf?n=448 (accessed 27 September 2011).
- www.aakp.org/newsletters/Home-Magazine/ On-the-Cover/Home-Options/ (accessed 27 September 2011).
- 2008 Veterans Administration Patient Safety Advisory Bleeding Episodes During Dialysis, available at: www.patientsafety.gov/alerts.html (accessed 27 September 2011).
- Mactier R, Worth DP, Minimizing the risk of venous needle dislodgement during hemodialysis, The Artery, 2007;41:9–11.
- ECRI: Undetected Venous Line Needle Dislodgement during Hemodialysis, available at: www.mdsr.ecri.org/summary/detail.aspx?doc_id=8300 (accessed 27 September 2011).
- EDTNA: Venous Needle Dislodgement (VND) How To Minimize The Risks, available at: www.edtnaerca.org/pdf/home/Edtna_poster_UK.pdf (accessed 27 September 2011).
- http://redsensemedical.com/Pages/StartPage.aspx (accessed 27 September 2011)
- Van Waeleghem JP, Chammney M, Lindley EJ, Pancírová J, Venous needle dislodgement: how to minimise the risks, J Ren Care, 2008;34:163–8.
- Shander A, Hofmann A, Ozawa S, et al., Activity-based costs of blood transfusions in surgical patients at four hospitals, Transfusion, 2010;50:753–65.
- European Dialysis and Transplant Nurses Association/European Renal Care Association, Assessment of the risk for a serious Venous Needle Dislodgement incident, 2011. Available at: www.edtnaerca.org/pages/erb/venousneedle.php (accessed 27 September 2011).
