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About Preventing Dangerous Hemodialysis Catheter Disconnections


Ten minutes after a patient began receiving a hemodialysis treatment, his venous blood line separated from the catheter. Shortly after the venous blood line was clamped, the patient complained of shortness of breath. His respirations were labored at a rate of 28 to 32 breaths/minute. He was immediately placed on his left side in Trendelenburg's position, started on 10 liters/minute of oxygen by face mask, and transported to the hospital. Despite these measures, he died of an air embolism.

 

What went wrong?

 

An implanted or nonimplanted hemodialysis catheter can be used as a "bridge" device until the patient's arteriovenous graft or native fistula is ready to be used. If the hemodialysis catheter inadvertently separates from the venous blood line, the patient can suffer an air embolism or quickly lose a large amount of blood.

 

When a catheter separates, the hemodialysis machine's alarm doesn't always go off. Its venous pressure monitor triggers an alarm when the venous blood line falls below the limit set by the user.

 

A patient can lose 200 to 250 mL/minute of blood when a catheter separates. The rate of blood loss varies depending on the rate at which the blood is being pumped through the hemodialysis machine.

 

The Food and Drug Administration (FDA) has received adverse event reports describing hemodialysis catheters that have separated, leaked, cracked, torn, or broken, leading to infection, air embolism, blood loss, additional surgery, or death.

 

( http://www.fda.gov/cdrh/medicaldevicesafety/
tipsarticles/catheter.html )

 

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