But I also had a chance to listen to several speakers before returning to Seattle. One was Lynda Ball, MSN, RN, CNN - who spoke about the alarming topic of "Fatal Vascular Access Hemorrhage." Can you imagine?
Here are some important take-home points from Lynda's talk:
- Fatal vascular access hemorrhage accounts for 0.4 to 1.6 percent of all ESRD patient deaths annually (230 episodes annually in US)
- 75% had access complications within 6 months (meaning there were some warning clues)!
- The majority of these events occur away from a dialysis facility, e.g. SNF, home, jail.
Aneurysms in a fistula can occur from repeated punctures in the same location. The skin can become shiny and smooth, but it is also stretched. The patient is likely to request a puncture at this site because it hurts less - but the skin can become thinned, and can rupture like an inflated balloon!
Any skin breakdown, ulceration, infection, or prolonged scabbing at the puncture site should prompt further evaluation.
Emergency measures in the case of spontaneous access hemorrhage include:
- Direct pressure
- Elevation about heart level
- Calling 911.
When I speak in various locations, I'm impressed with the hard work and sincerity of the people who work in the area of dialysis: people who are clearly trying to make things better for people traveling this tough road of CKD.
Linda Gromko MD
PS - Please take a moment to look at my medical practice's updated website: www.QueenAnneMedicalAssociates.com.