By Jane Hurst, RN
,CLNC
As you know, being on hemodialysis is a crucial but complex procedure which involves a certain level of risk. As a dialysis patient you get used to keeping an eye out for infections, phosphate levels, and access complications. We can’t dwell too much on things which may happen, but a certain level of consciousness can help you feel on top of things. Venous needle dislodgement during hemodialysis is rare, but incidents do occur and they can have serious consequences. Do you know what to do should this happen to you?
Background
If the artery needle is dislodged during hemodialysis, the dialysis machine will stop within seconds. But if the venous needle is dislodged, the machine will often continue to draw the patient’s blood until the machine is turned off manually. Significant blood loss can occur when the venous needle becomes dislodged. This is the reason dialysis patients must never cover their access arm under blankets or clothes. The access point must be visible for safety .
Dialysis equipment must, according to standards, provide a system to protect the patient from blood loss due to dislodgement of the venous needle. Although it is permissible that this requirement can be met by a built-in function in the dialysis machine called venous pressure monitoring, a better solution has long been requested by patients and medical staff.
The fact that there is no adequate alarm to detect this dislodgement is often not known by patients or staff. Most believe that venous pressure monitoring will pick up the dislodgement. But in most cases, this alarm sounds too late, if at all.
Who’s at Risk?
Patients considered at high-risk for needle dislodgement have typically been those with a medical condition or behavior which causes restlessness. Some sources estimate an increased risk during the last two hours of dialysis, when some patients become more restless. No, or poor, visibility of the access site due to the patient occupying a single room or receiving nocturnal dialysis in wards with lights out are other factors that may affect the risk[1]
However, studies of incidents showed that the typical scenario of venous needle dislodgement episodes happened in apparently routine treatments and with fully staffed units. In most reported episodes, there was no observed event that led to dislodgement of the needle[2]
It’s not all about the level of monitoring or methods of securing the needle. A general raised awareness is also important. As renal failure continues to be a growing problem, dialysis clinics get busier. The added difficulty of trying to keep an eye on the growing number of dialysis patients’ access sites to monitor for bleeding puts extra pressure on the staff.
What Can You Do? 
If you’re in daytime hemodialysis, keep an eye on your venous needle and make sure it is visible to staff. Be aware that even a small piece of tape used to secure the needle may catch on your clothing, blanket, etc. causing the needle to pull or dislodge. Encourage staff to take extra care when taping the needle. Check with your clinic regarding their 
routine for monitoring the venous access point (some units
check on regular intervals).
A new external blood loss detection device called Redsense, the first one which has been specifically developed to detect venous needle dislodgement, is available on the market. You could check whether it is used by your clinic.
Remember that incidents are rare but that you can make your treatment safer by being aware of risks as well as possibilities.
About the Author
Jane Hurst has been an RN for 28 years. She has experience in many medical specialties and areas of the hospital. In 1992, Jane started her legal nurse consulting business, RN Services Legal Nurse Consulting. She uses her experience and medical knowledge to assist attorneys, insurance companies, government agencies, and private corporations with all of their medical-legal needs. In addition to her business, Jane also travels across the country teaching in the largest, most well-respected training program for certified legal nurse consultants.
[1]Mactier, R.A & Worth, D. P. Minimizing the Risk of Venous Needle Dislodgement during Hemodialysis. The Artery, issue 41, 2007
[2]Sandroni S. Venous needle dislodgement during hemodialysis: An unresolved risk of catastrophic hemorrhage. Hemodialysis International 2005; 9:102
Last Updated December 2008