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Publication Type: Patient Safety Alert
Single or Multiple Incident: Multiple
Date: 11/12/2018 12:00:00 AM
Country: United Kingdom
Organization: NHS Commissioning Board

This alert discusses the potential for life threatening blood loss from an arteriovenous fistula (AVF) or arteriovenous graft (AVG) site. Haemodialysis removes the waste products and extra fluid that build up in the blood of those whose kidneys no longer function properly and relies on easy access to a patient’s blood vessels. Preferred methods for permanent access are an arteriovenous fistula (AVF) or arteriovenous graft (AVG) that provide a connection between the artery and vein allowing for an increased blood flow rate and faster removal of toxins from the blood during dialysis. Blood loss from an AVF or AVG can usually be controlled by applying pressure to the site. However, rarely bleeds do not resolve and, due to the rate and volume of blood loss, become life threatening. Although life threatening bleeds (LTB) can occur without warning, occasionally warning signs of a potential bleed are not recognized. This alert provides resources available on the NHS Improvement website which will help staff, carers and patients recognise warning signs, such as changes in skin appearance or condition, that could indicate a risk of LTB and provides a tool that enables staff to risk assess AVF and AVGs prior to use. Resources are also available that assist patients, their families and carers, and healthcare staff to promptly and effectively manage a LTB should it occur. Recommended actions are provided for the detection and management of life threatening bleeds from arteriovenous fistulae and grafts.

Management of life threatening bleeds from arteriovenous fistulae and grafts