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NHS safety alert issued over life-threatening kidney dialysis bleeds

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Healthcare staff across England have been urgently reminded about how to spot warning signs of life-threatening bleeding in kidney dialysis patients following seven deaths.

It is believed lives could be saved if all relevant NHS workers and patients were aware the early indicators of a serious bleed and what action to take in these circumstances.

“In a very tiny number of cases patient’s lives can be at risk if the warning signs of a potentially life-threatening bleed are not known”

Kathy McLean

The safety alert (see PDF attached) has been issued because NHS Improvement received 11 reports between May 2015 and 30 April 2018 of people suffering life-threatening bleeds from types of dialysis where an artery connects to the vein to give access to the blood – known as arteriovenous fistula (AVF) or arteriovenous grafts (AFG). In seven of these cases the patient died.

While bleeding from these types of access point is not uncommon and can usually be stemmed by the application of direct pressure, on some occasions the patient will require urgent professional support to stop the bleeding.

According to NHS Improvement, warning signs of a critical bleed include: non-healing scabs, signs of infection around the wound, or shiny skin in or around the area where a patient is connected to the dialysis machine.

Kidney dialysis is often performed in hospital, though many patients do it themselves at home. NHS Improvement has therefore asked NHS staff to also educate kidney dialysis patients about the warning signs of a life-threatening bleed and what to do if one occurs.

More than 57,000 adults in the UK receive treatment for kidney failure. Of these 26,742 patients receive kidney dialysis, with an estimated 15,500 using arteriovenous fistula (AVF) or arteriovenous grafts (AFG).

Leaders reassured that the occurrence of a severe bleed was rare, and that kidney dialysis remained a life-saving intervention.

“It is important that patients and staff are aware of the simple actions to take to ensure this bleeding is not life-threatening”

Catherine Fielding

The patient safety alert was issued to NHS organisations in England by NHS Improvement in partnership with the British Renal Society and the Vascular Access Society of Britain and Ireland.

It refers solely to patients who are connected to the dialysis machine through AVF and AFG.

Kathy McLean, executive medical director and chief operating officer at NHS Improvement, said: “Kidney dialysis can significantly increase the length of a patient’s life. 

NHS Improvement

Kathy mc lean

Kathy McLean

“In a very tiny number of cases patient’s lives can be at risk if the warning signs of a potentially life-threatening bleed are not known,” she added.

“Staff and patients understanding the early warning signs of this type of bleed will help save lives,” Ms Mclean said. 

Guidance has urged that should a patient find they are bleeding through their dressing despite applying pressure to the AVF or AVG site, they should call 999 immediately. While waiting for emergency assistance, they should apply pressure on the wound using a small rigid object such as a large bottle top, hollow side down.

Catherine Fielding, co-chair of the British Renal Society’s Vascular Access special interest group, reiterated that enduring a life-threatening bleed from AVF or AFG was “very rare”.

“The majority of patients using a fistula or graft for haemodialysis will never experience this, but on very rare occasions bleeding can be excessive and difficult to stop,” she said.

“It is important that patients and staff are aware of the simple actions to take to ensure this bleeding is not life-threatening,” she added. 

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