Hemodialysis taping styles and their effect on reducing the chance of venous needle dislodgement

A system for preventing internal fistula needle dislodgement: Delphi study and pilot evaluation

AIM

To establish a scoring system for risk assessment (SSRA) for internal fistula needle dislodgement (IND) in hemodialysis (HD) patients.

METHODS

The SSRA was constructed based on literature search, medical history review, expert consultations, expert meeting (Delphi study), and analytic hierarchy process. Then, a pilot test was conducted at our hospital between August 1, 2020, and July 30, 2021. Consecutive patients requiring HD were included and randomly assigned to experimental and control groups (1:1 ratio). Control group was treated with the routine procedures, while the experimental group was treated with strengthened nursing measures based on the individual risk assessed by SSRA. Finally, the incidence of IND was compared between the two groups.

RESULTS

For the Delphi study, 16 experts in dialysis nursing in Zhejiang, Shanghai, Guangzhou, and Qinghai were included. The final draft of the SSRA included three first-level indices, 11 second-level indices, and 26 third-level indices. A total of 218 HD patients were included. The IND rate in the experimental group was significantly lower than that in the control group (p < .01).

CONCLUSION

We established a scientific, reliable, and feasible SSRA for timely identification of HD patients with high risk of IND and the corresponding nursing procedures to prevent IND.

Risk assessment of failure during transitioning from in-centre to home haemodialysis

BACKGROUND

Introducing a de-novo home haemodialysis (HHD) program often raises safety concerns as errors could potentially lead to serious adverse events. Despite the complexity of performing haemodialysis at home without the supervision of healthcare staff, HHD has a good safety record. We aim to pre-emptively identify and reduce the risks to our new HHD program by risk assessment and using failure mode and effects analysis (FMEA) to identify potential defects in the design and planning of HHD.

METHODS

We performed a general risk assessment of failure during transitioning from in-centre to HHD with a failure mode and effects analysis focused on the highest areas of failure. We collaborated with key team members from a well-established HHD program and one HHD patient. Risk assessment was conducted separately and then through video conference meetings for joint deliberation. We listed all key processes, sub-processes, step and then identified failure mode by scoring based on risk priority numbers. Solutions were then designed to eliminate and mitigate risk.

RESULTS

Transitioning to HHD was found to have the highest risk of failure with 3 main processes and 34 steps. We identified a total of 59 areas with potential failures. The median and mean risk priority number (RPN) scores from failure mode effect analysis were 5 and 38, with the highest RPN related to vascular access at 256. As many failure modes with high RPN scores were related to vascular access, we focussed on FMEA by identifying the risk mitigation strategies and possible solutions in all 9 areas in access-related medical emergencies in a bundled- approach. We discussed, the risk reduction areas of setting up HHD and how to address incidents that occurred and those not preventable.

CONCLUSIONS

We developed a safety framework for a de-novo HHD program by performing FMEA in high-risk areas. The involvement of two teams with different clinical experience for HHD allowed us to successfully pre-emptively identify risks and develop solutions.

The development and testing of a prototype venous needle dislodgement detection device

Inadvertent venous needle dislodgement (VND), from graft or arterio-venular fistula, can lead to haemorrhage resulting in a serious life-threatening complication and in some cases death by exsanguination. This paper eloquently articulates the development and testing of a novel Arduino based VND detection device. The VND detector is subjected to four testing protocols to critically analyse the efficiency of VND detection within a 12-second window. Implementation of statistical analytic methods to the obtained results successfully demonstrated the VND detector's ability to detect VND within 12 seconds.