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.
