Question #1: You may ask, “Why, oh why, must I keep my access uncovered during the hemodialysis treatment? Is it really that important or just another one of those rules?”
Answer: Yes, it is a DaVita rule. It is also a government mandate. Plus, to prevent unnecessary blood loss, it is important for your safety.
Question #2: You are asleep, covered with your favorite blanket. About half way into the run, your venous needle comes out, without you noticing. How much blood could you lose in only one minute?
Select the best answer.
- Very little. The machine would immediately alarm and the blood pump would stop.
- About 100 ml (onehalf cup)
- About 200 ml (one cup)
- At least 400 ml (one pint)
Answer: If most cases “A” would occur. When a needle comes out of the access vessel, the pressure inside the venous dripchamber pressure often decreases to the point that an alarm occurs and blood pump immediately stops. In some cases, however, the dripchamber pressure may not fall out of the preset acceptable range and no alarm sounds. When no alarm occurs, the blood pump would continue to pull blood from the body via the arterial needle, and then pump this blood into the chair. The venous needle site also would bleed. In this situation, the best answer is “D”. Within minutes, a large volume of blood can be lost. But, you say, if this would happen, you would immediately wake up and call for help.
Yes, that may occur, but there is no guarantee. When a patient covers an access site, it may prevent teammates from being able to see any bleeding from the access.
Prevention is key. Your role includes:
- If you notice tape is no longer sticking to your arm or to the needle, let someone know.
- If you notice blood oozing from the needle site, let someone know. It may mean the needle is no longer completely inserted.
- Keep your access arm still during the treatment.
- If a needle should come out, get someone’s attention – immediately!
If you access arm is cold when not covered, consider bringing something to dialysis that is small and can cover the arm below the access, possibly a small towel or a glove. The only area that must remain uncovered is where the needles enter the skin. (With a catheter, both the exit site and the connections should remain uncovered and easy to see)