NHS Improvement issues alert to spot bleeding in patients with kidney dialysis

An alert has been issued to help staff spot the warning signs of life-threatening bleeding in patients who have kidney dialysis.

Between May 2015 and 30 April 2018 NHS Improvement received 11 reports of cases where patients had life-threatening bleeds from types of dialysis where an artery connects to the vein to give access to the blood. In seven of these cases a patient died.

Bleeding from these types of access points is not uncommon and can usually be stemmed by the application of direct pressure. But on some occasions the bleeding cannot be stopped and the patient requires urgent support to stop the bleeding. In such a circumstance a patient may need urgent assessment by a specialist such as a vascular surgeon.

Kidney dialysis is often performed in hospital however many patients perform it themselves at home. NHS Improvement is urging the NHS to educate kidney dialysis patients about the warning signs of life-threatening bleeds and what to do if it happens to them.

Kathy Mclean, Executive Medical Director and Chief Operating Officer at NHS Improvement said: “Kidney dialysis can significantly increase the length of a patient’s life. In a very tiny number of cases patients’ lives can be at risk if the warning signs of a potentially life-threatening bleed are not known.

“Staff and patients understanding the early warning signs of this type of bleed will help save lives.”

Warning signs of a potential life-threatening bleed includes non-healing scabs, signs of infection around the wound, or shiny skin in or around the area where a patient is connected to the dialysis machine. The alert refers solely to patients who are connected to the dialysis machine through two specific forms of access to the blood – an arteriovenous fistula (AVF) or arteriovenous grafts (AFG).

More than 57,000 adults in the UK receive treatment for kidney failure. Of these 26,742 patients receive kidney dialysis, with an estimated 15,500 of these patients using AVF or AVG.

NHS Improvement has written to all NHS organisations to ensure staff and patients are aware of the warning signs of life-threatening bleeds in patients who receive kidney dialysis.

Catherine Fielding, co-chair of the British Renal Society’s Vascular Access special interest group said: “Having a life-threatening bleed from an arteriovenous fistula or graft is a very rare event. The majority of patients using a fistula or graft for haemodialysis will never experience this, but on very rare occasions bleeding can be excessive and difficult to stop. It is important that patients and staff are aware of the simple actions to take to ensure this bleeding is not life-threatening.

“If you start bleeding from your fistula or graft excessively, you should immediately call the emergency services. You can also apply pressure to the bleeding site to help stem the flow of blood.  Ideally a bottle top, placed rim downwards over the site, is best at stopping or reducing the bleeding, although any flat, rigid object can be used if a bottle top is not to hand. A soft object like a towel will disperse the pressure and may not be as effective at stopping the bleeding.”