RISK MANAGEMENT

Possible risk patients & situations

Step 1 – Factors affecting how well secured the needles are

These risk factors will make it more likely that a VND incident will occur, either due to a higher risk of tugging on the lines connected to the needles, or to a higher risk of the taping of the needles not being able to hold the needles in place.

  • Patients prone to erratic or restless behaviour, e.g. intradialytic hypotension, cramping.
  • Patients with a history of VND.
  • Patients with oozing around venous needle.
  • Patients who have a high degree of sweating.

Step 2 – Factors affecting the ability of staff/carers/other patients to monitor patients

These risk factors will make it less likely that in the event of a VND event, healthcare professionals, carers or other patients will observe the incident and either take suitable remedial action or raise the alarm for somebody else to act.

  • Poor lighting in the room.
  • Patients covering the access during dialysis.
  • Dialysing in isolation rooms.
  • Self care or minimal care units.
  • Inadequate staffing levels. 

Step 3 – Factors affecting the ability of patients to monitor themselves

These risk factors will make it less likely that the patient who has suffered a VND event will notice that it has occurred and either take suitable remedial action or raise the alarm for somebody else to act.

  • Tendency to sleep during dialysis.
  • Mental or cognitive impairment, e.g. dementia.
  • Temperature/fever.
  • Reduced sensitivity.

Step 4 – Factors affecting the ability of the dialysis machine to monitor patients

These risk factors will make it less likely that in the event of a VND event, the dialysis machine will raise the alarm so that somebody can take suitable remedial action.

  • Inappropriate setting of venous pressure alarms.
  • Frequent false alarms causing alarm fatigue.