Question

Henry Baer, below, with his mother, Violet Cunningham. Baer, 39, died from an antibiotic-resistant staph infection after his bloodline had become disconnected during a dialysis treatment. (Photo courtesy of Karen Gable) Henry Baer went in for his third dialysis treatment on New Year's Eve day in 2005. It turned out to be his last. He was only 39, but years of diabetes and high blood pressure had caused Baer's kidneys to shut down. Built-up waste and fluid were causing his limbs to swell and making him short of breath. He was sent for what's called in-center hemodialysis, the most common type of dialysis, at a beige-toned clinic near his home in Prescott Valley, Ariz. His first two sessions were pretty normal. A patient-care technician hooked Baer to a machine the size of a filing cabinet, connecting it with plastic tubing to the catheter in his chest. He sat in a lounge chair, still as stone, for about four hours as the machine, whirring gently, moved his blood through a specialized filter, then returned it, cleansed of toxins. It was uncomfortable and boring. "Sis, this isn't for me," he told his older sister, Karen Gable, vowing to make himself a viable candidate for a kidney transplant. Just over two hours into his next session, Baer's incoming bloodline "became disconnected," a federal inspection report says. The attending technician panicked, "yelling and screaming hysterically." Blood sprayed onto Baer's shirt, pants, arms and hands. Then, "contrary to emergency standing orders," the report continued, she reconnected the line to Baer's catheter, infusing him with "potentially contaminated blood." By the time Mike Wright, Baer's boss at a local car dealership, picked Baer up after the treatment, he was complaining of nausea. Over the next two days, Baer spiked a fever. His wife found him in bed, having a convulsion. He was taken to the hospital, where tests later showed that his catheter had become infected with antibiotic-resistant staph. The infection moved swiftly to his heart and brain. He died a few days later, on Jan. 7, 2006, leaving behind a 2-month-old daughter.

Questions: 1. What is venous needle dislodgement (VND)?

2. What causes VND?

3. What are the consequences of VND?

4. What are the risk factors for VND?

5. How do you prevent VND?

Answer 1

1) venous needle dislodgement

A complication of hemodialysis that occurs when the venous fistula needle becomes dislocated out of the vascular access, resulting blood loss.

Ranges from minor blood loss to exsanguination (bleeding to death)

2) causes of VND

VND occurs when the needle delivering the cleansed blood from the machine back into the patient either partially or completely comes out of the access site. Instead of blood being pumped back into the patients bloodstream, it flows onto the bed, chair ,even the floor.

3)Consequences of VND

Patients who lose more than 40% of their  blood are more likely to suffer from permanent life altering consequences such as stroke, and other permanent disabilities.

Instances of VND can be expensive, requiring emergency care and hospitalization.

4) risk factors for VND

* restless,confused,agitated,and uncoperative patients.

* lack of supervision by the healthcare personnel.

*patients whose access is covered during dialysis

* patients who are mentally,cognitively ,and neurologically impaired, such as those with dementia

*patients with frequent blood pressure drops or muscle cramps.

*patients with extensive hair growth around the access site which makes fixation of the needles more difficult.

*patients with skin conditions such as allergic to patches, eczemas,and extensive sweating

*patients with fistulas located other than cephalica or brachea eg: locations which are not visible easily submitted to friction.

* patient with small blood leakage oozing around the venous needle.

*patients with diabetes and frequent hypoglycemic episodes during HD therapy.

5)prevention of VND

Visually monitoring the status of the needle insertion site and blood lines is the first line of defense in detecting VND.

* the access site should remain uncovered allowing for easy visual inspection

* agitated and confused patients should be supervised by the nurse very frequently

* the needle should be taped securely.

* use of standard taping procedure makes it easier for staff to identify insecure initial fixation and any movement of the tape during dialysis.

* blood lines should be anchored to the patient, not to the chair or bed. This reduces the chances that the lines could be pulled on hard enough to dislodge the needle.

* blood lines should be looped loosely to allow movement of the patient and to prevent blood lines pulling on the needle.

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