Venous Needle Dislodgement - A safety problem
Dr. Sandroni published in 2009 that 0.0003% of VND incidents are fatal and 0.0008% are serious1. The Department of Veteran Affairs presented similar data in 2008, showing 0.0016% of VND´s are serious.17 VND incident rates, from RPA in 2007 show 0.1282% incident rate and data from Dr. Ahlmén in 2008 show 0.1736%.2, 3
1 Sandroni, S, Shockerman, T, Hayes-Light, K, Catastrophic Hemorrhage from Venous Needle Dislodgment during Hemodialysis, Journal of the American Society of Nephrology, volume 9, November 2008, Abstract issue.
2 RPA Renal Physicians Association, Health and Safety Survey to improve patients safety in end stage renal disease (2007)
3 Ahlmén J, Gydell KH, Hadimeri H, Hernandez I, Rogland B, Strömbom U, (2008) A new safety device for hemodialysis, Hemodialysis International 12 (2), Page 264-267.
Globally this would mean that:
EDTNA/ERCA questionnaire recordings of 283 VND incidents indicate that 23% of VND's are serious and severe needing resuscitation to save patients lives and 5% either died or suffer from long term sequelae.
Hemodialysis 15 hours per week
During Hemodialysis blood is cleared from waste products when our kidneys fail to do so. A typical dialysis session lasts 4-5 hours and is completed 3 times weekly. Throughout the world 2.5 million patients receive hemodialysis.
During each dialysis session the blood access site is punctured with two needles. The blood is pumped through an artificial kidney where the blood is cleared from waste products before being returned to the patient in a loop.
A serious complication
Venous needle dislodgement, VND, is when the needle slips out and the returning blood is pumped onto the bed or chair instead of back to the patient's bloodstream. As much as 400-500 ml of blood is lost every minute and if not detected immediately the consequences may be catastrophic and in some cases fatal.
The hemodialysis equipment used today are not equipped to detect VND reliably. The method of detection is limited to pressure measurements. When the venous needle is dislodged the pressure drop is often too small to activate the system.
Measures for detection
VND can happen to anyone. Every attempt should be made to minimize the risk, and protection such as Redsense can be used to detect blood loss.