Venous needle dislodgement

Venous needle dislodgement (VND) is a rare but potentially life-threatening complication that may arise in conjunction with hemodialysis treatment.
Causes
During hemodialysis, the blood of a patient with insufficient renal function is purified outside the body by circulating the blood volume through a dialyzer.
Venous needle dislodgement occurs when the venous needle accidentally comes out of the access point during the dialysis session for some reason, causing leakage and preventing the purified blood from being returned to the bloodstream. This can happen if the needle is not secured correctly or if it is pulled. A literature review and survey among nephrology nurses conducted in 2012 by the American Nephrology Nurses' Association (ANNA) identified access care and patient factors as underlying causes, including improper taping, loose luer lock tubing connection, poor looping of bloodlines, and patients pulling their own needles out of confusion.
If a venous needle dislodgement is not detected so that the dialyzer's pump can be stopped, the patient will immediately begin to experience blood loss and could potentially bleed to death within minutes. The cycle rate of modern dialysis machines has increased, which has made dislodgements more dangerous as there is less time to react before significant blood loss occurs. The normal variation over the course of a session may, however, be of the same magnitude (30-40 mmHg) as an acute decrease following dislodgement; there is thus a trade-off between detecting all emergencies and avoiding repeated false pressure alarms. Various external sensors for detecting leakage after the fact have been developed. A 2017 review published in the Clinical Journal of the American Society of Nephrology identified a number of studies where the frequency of major hemorrhage due to VND was found to be between one in 11,000 sessions and one in 70,000 sessions.<ref name=":1" />

Main Menu

See Also

Main Menu