Friday, September 19, 2014

Fargo Trip Brings Important Information: Fatal Vascular Access Hemorrhages

I was invited to speak at the 13th Annual Sanford Kidney Services Nephrology, Dialysis & Transplant Symposium September 17. My topic - one of my favorites - was "What My Husband's Kidney Failure Taught Me About My Own Profession."

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.
Lynda stressed the importance of evaluating the patient for access complications such as stenosis, ulceration, infection, and non-fatal hemorrage. She reminded us that it's important to ask the patient, "Have you had any bleeding at your access site since your last dialysis?"

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.
Good to know.

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.

Take care,
Linda Gromko MD
PS - Please take a moment to look at my medical practice's updated website:


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  2. I find it extremely important to note that many AV Fistula placement is often in the upper arm. My husband had one created by Dr Mark Webb, of Southfield, MI, in his right upper arm where as I have the wonderful training provided by our local renal center and the Fistula works wonderfully!!! The upper arm is a safer site as well. Dr Gromko needs to be aware that, here in Michigan,, the upper arm is often preferred rather than lower. We use NxStage equipment for 2.25 6x weekly home dialysis. We also use equipment making dialysate rather than the hanging bags mentioned in your books. Daily runs are never longer than four hours even at a slow rate of 200. I love doing this early each morning!

    1. Thanks for your comments. The new reverse osmosis method of preparing dialysate wasn't available when my husband started dialysis at home. My understanding is that fistulas are placed preferentially in the upper arm, but that individual anatomy may make the forearm or even the thigh desirable sites. I like your description of doing dialysis early in the morning - a good way to start your day. This is a great reminder of the flexibility home hemo offers! Thank you. Linda