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Nursing Homes Abuse Blog By Jonathan Rosenfeld

Dialysis Related Injuries Can Be Prevented With Basic Precautions

Posted in Nursing Home Injury

dialysisWhen a person’s kidneys no longer work properly, dialysis can filter waste products from their blood.  Your kidneys keep your blood clean and balanced.  They filter 200 quarts of blood every day, filtering out waste and excess water, which becomes urine. 

Diabetes and high blood pressure are the two most common causes of kidney disease.  As your kidney health declines, your renal function worsens. 

If your kidneys have less than 25% of their kidney function, serious health problems can occur.  And, if your kidneys have less than 15% of their kidney function, dialysis or kidney transplant is required. 

About 11.5% of adults (ages 20+) in the United States show evidence of chronic kidney disease (CKD).  Signs of chronic kidney disease include:

  • Increase or decrease in frequency of urination
  • Fatigue
  • Loss of appetite
  • Swollen hands or feet
  • Itchiness or numbness
  • Drowsiness
  • Trouble concentrating
  • Muscle cramps
  • Darkened skin

When the kidneys have failed or are close to failing (End-stage Renal Disease – ESRD), the body fills with waste and excess water (uremia).  If left untreated, this can lead to seizures, coma, and even death.  Treatment options are dialysis or kidney transplant.  In 2007, in the United States, mortality rates for ESRD were 157.3 deaths for every 1,000 patient years. 

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There are two types of dialysis: hemodialysis and peritoneal dialysis.  Hemodialysis involves a dialyzer filter that connected to a hemodialysis machine.  Your blood flows out one set of tubes to the dialyzer that filters the blood, then the clean blood flows back into your body through a second set of tubes.  The treatment takes about 3-4 hours and must be performed 3 times/week.  Peritoneal dialysis involves a dialysis fluid that is inserted into the abdomen that collects waste products then is drained with a catheter. 

Risk of dialysis-related injuries

One complication of peritoneal dialysis is infection because a tube goes from the peritoneal cavity to the outside of the body where bacteria could enter.  Therefore, the patient must take cleanliness seriously. 

Dialysis patients also have an increased risk of falls because of hemodynamic changes which can cause low blood pressure and dizziness.  Also, many dialysis patients are older adults who suffer from bone or muscle weakness and have limited mobility. 

The average age of dialysis patients is 65 years old.  Risk factors for dangerous falls include: low systolic blood pressure before dialysis, history of falls, low vitamin D levels, comorbidities, and old age.  Therefore, dialysis centers must take extra precautions to reduce the risk of falls including performing a fall assessment, use exercises to improve strength, and avoid low blood pressure.

Human error is another common complication of dialysis.  Dialysis treatment involves multiple medications, dialysis access, and dialysis equipment several times a week.  This poses a dangerous set of circumstances, where errors can have deadly results.  Possible problems include:

  • Medication errors
  • Dialysis solution (dialysate) could be contaminated
  • The wrong dialysate could be used
  • The dialyzer could leak
  • There could be problems with the patient’s access
  • Improper blood draws from area close to patient’s access site

One major problem in the 80′s was incorrect sterilization of dialyzer membranes, which allowed a patient to be exposed to another patient’s blood and all their associated diseases including Hepatitis and HIV.  To reduce such errors, the Association for the Advancement of Medical Instrumentation (AMMI) set dialyzer reuse standards.  Many patients refused to participate in the reuse programs, and providers favored single-use membranes. 

Dialysis is an important and lifesaving tool for patients with renal failure.  However, dialysis can also pose serious dangers.  Therefore, it is important that dialysis centers take precautions to reduce errors and promote patient health and safety.

Resources:

MedicineNet; Dialysis

Agency for Healthcare Research and Quality: Dangerous Dialysis

Heartland Kidney Network Quality Improvement Department: Fact Sheet – Patient Safety in the Dialysis Facility

Clinical Journal of the American Society of Nephrology: Falls and Fall-Related Injuries in Older Dialysis Patients

International Urology and Nephrology: Prevalence of Falls Among Seniors Maintained on Hemodialysis

National Kidney and Urologic Diseases Information Clearinghouse: Kidneys

  • http://www.dlgrace.com dee grace

    Wow, am I impressed with your writing and your topic. The old are always the last thought of!! It’s wonderful to know someone cares enough to bring this common occurrence out from behind closed doors! Bless you, Dee

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