Rare Complications in Dialysis: In a quiet corner of West Virginia, Nieltje Gedney experienced a horrifying incident while undergoing her hemodialysis treatment. Half-asleep and engrossed in murder mysteries, she suddenly felt something warm and wet in her armpit. A needle inserted into her arm had become loose, causing a disruption in the circuit that cleaned her blood. Instead of returning to her body, the blood was now spilling onto her bed.
The Danger of Venous Needle Dislodgment (VND)
What Gedney experienced that night was a rare and highly dangerous complication of hemodialysis called venous needle dislodgment (VND). Hemodialysis is a life-saving treatment that hundreds of thousands of Americans with kidney failure rely on to mimic the function of healthy kidneys. The process involves pumping the patient’s blood through an external cleaning machine. However, if the venous needle dislodges during this process, the machine continues to pump and clean blood, but the blood escapes the body. Unless someone intervenes promptly, the patient can die within minutes.
A Solution in Europe, but Not in the US
Interestingly, Europe has a relatively simple solution to address this issue. An alarm system is available that detects blood loss using a disposable sensor patch and automatically shuts off the dialysis pump. This fail-safe technology could save lives, but dialysis companies in the United States have been hesitant to embrace it. As a result, this life-saving alarm system is largely unavailable to American patients.
Changing Landscape of Hemodialysis
In recent years, there has been a shift in the way hemodialysis is administered. Both the Trump and Biden administrations have promoted home dialysis by increasing Medicare payments. This shift allows patients to receive treatment in the comfort of their own homes, often with the assistance of family members or caregivers. Home dialysis offers several advantages, including better results, increased independence, lower overall costs for the government and insurers, and reduced stress on patients’ bodies.
The Widowmaker Heart Attack of Dialysis
Ankur Shah, a nephrologist at Brown University, describes VND as the “widowmaker heart attack of dialysis.” He emphasizes the critical nature of timely intervention, as a few minutes of delay can be life-threatening. Patients who experience VND at home face the daunting task of recognizing the problem and taking action while their bodies are already going into shock.
Dialysis Machines and Safety Measures
In the United States, there are only a few home hemodialysis machines approved by the FDA. One such machine is the Tablo from Outset Medical, which resembles a mini-fridge. The company claims to have received no reports of VNDs among Tablo patients at home. They attribute this to the training patients receive and the simplicity of the procedure: stop the blood pump.
On the other hand, Fresenius, one of the world’s largest dialysis companies, has been selling NxStage hemodialysis machines for home use in the US since 2005 but declined to comment on this matter.
Lack of Data and Research
Surprisingly, there is no comprehensive tracking of VND incidents in the US. The National Institutes of Health, which maintains extensive data on kidney failure and dialysis patients, does not specifically track VND events in clinics or at home. While dialysis companies are required to log these incidents internally, there is no obligation to report them to the government or the public.
The Potential of Alarms and Solutions
One company making strides in dialysis safety is Redsense Medical, a Swedish company that produces dialysis safety products. Their stand-alone alarm system, used in some clinics and by home patients worldwide, has a blood sensor patch thatdetects a needle dislodgment and triggers an alarm with flashing lights. Redsense alarms can also send a signal to automatically turn off the blood pump without human intervention.
However, the full potential of these alarms has not been realized. Although the technology for automatic shut-off exists, it has not been integrated into hemodialysis machines used in the US. The lack of interest from companies in utilizing this feature has prevented its submission to the FDA for approval.
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Medicare Coverage and Legislative Efforts
Currently, Medicare does not provide coverage for VND alarms. Recognizing the urgency of the situation, Representatives Adrian Smith and Melanie Stansbury introduced the “Home Dialysis Risk Prevention Act.” This proposed legislation aims to extend Medicare coverage to VND alarms and related supplies for home patients. It seeks to align public policy with technological advancements and encourage innovation for the benefit of patients.
Conclusion of Rare Complications in Dialysis
The occurrence of venous needle dislodgment in hemodialysis is a serious and potentially fatal complication. While a solution exists in Europe, its implementation in the United States has been hindered by cost and lack of Medicare coverage. The increasing popularity of home dialysis brings both opportunities and challenges, including the increased risk of VND for patients dialyzing at home. It is crucial for dialysis companies, healthcare providers, and policymakers to collaborate in implementing safety measures such as alarm systems to prevent VND and protect the lives of dialysis patients. Additionally, extending Medicare coverage for VND alarms can ensure accessibility and affordability, fostering innovation and improving patient outcomes in the field of hemodialysis.
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Our Reader’s Queries
What is the most serious complication of dialysis patients?
Haemodialysis patients have a higher chance of getting sepsis, also known as blood poisoning. This happens when bacteria invade the body and move through the bloodstream, which could result in multiple organ failure.
What is the life expectancy of a person on dialysis?
The length of time you can live on dialysis depends on your other health issues and how closely you stick to your treatment plan. Most people on dialysis can expect to live around 5-10 years, but some have thrived on dialysis for 20 or even 30 years.
What are dialysis patients prone to?
Skin, blood, or peritoneum infection can lead to sepsis, a serious condition that can cause multiple organ failure. Fatigue is a common issue for those on long-term dialysis, but can impact anyone.
What is the longest someone has lived after stopping dialysis?
Patients ceasing dialysis can survive for a period ranging from one week to multiple weeks, contingent on the level of kidney function remaining and their overall health status.