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      El documento Código fístula: un consenso histórico Translated title: The Code fistula document: a historical agreement

      editorial
      Enfermería Nefrológica
      Sociedad Española de Enfermería Nefrológica

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          Diagnosis, Treatment, and Prevention of Hemodialysis Emergencies

          Given the high comorbidity in patients on hemodialysis and the complexity of the dialysis treatment, it is remarkable how rarely a life-threatening complication occurs during dialysis. The low rate of dialysis emergencies can be attributed to numerous safety features in modern dialysis machines; meticulous treatment and testing of the dialysate solution to prevent exposure to trace elements, toxins, and pathogens; adherence to detailed treatment protocols; and extensive training of dialysis staff to handle medical emergencies. Most hemodialysis emergencies can be attributed to human error. A smaller number are due to rare idiosyncratic reactions. In this review, we highlight major emergencies that may occur during hemodialysis treatments, describe their pathogenesis, offer measures to minimize them, and provide specific interventions to prevent catastrophic consequences on the rare occasions when such emergencies arise. These emergencies include dialysis disequilibrium syndrome, venous air embolism, hemolysis, venous needle dislodgement, vascular access hemorrhage, major allergic reactions to the dialyzer or treatment medications, and disruption or contamination of the dialysis water system. Finally, we describe root cause analysis after a dialysis emergency has occurred to prevent a future recurrence.
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            Data from the ERA-EDTA Registry were examined for trends in excess mortality in European adults on kidney replacement therapy

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              Vascular access hemorrhages contribute to deaths among hemodialysis patients.

              In 2007 the Maryland Medical Examiner noted a potential cluster of fatal vascular access hemorrhages among hemodialysis patients, many of whom died outside of a health-care setting. To examine the epidemiology of fatal vascular access hemorrhages, we conducted a retrospective case review in District of Columbia, Maryland, and Virginia from January 2000 to July 2007 and a case-control study. Records from the Medical Examiner and Centers for Medicare and Medicaid Services were reviewed, from which 88 patients were identified as fatal vascular access hemorrhage cases. To assess risk factors, a subset of 20 cases from Maryland was compared to 38 controls randomly selected among hemodialysis patients who died from non-vascular access hemorrhage causes at the same Maryland facilities. Of the 88 confirmed cases, 55% hemorrhaged from arteriovenous grafts, 24% from arteriovenous fistulas, and 21% from central venous catheters. Of 82 case-patients with known location of hemorrhage, 78% occurred at home or in a nursing home. In the case-control analysis, statistically significant risk factors included the presence of an arteriovenous graft, access-related complications within 6 months of death, and hypertension; presence of a central venous catheter was significantly protective. Psychosocial factors and anticoagulant medications were not significant risk factors. Effective strategies to control vascular access hemorrhage in the home and further delineation of warning signs are needed.
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                Author and article information

                Journal
                enefro
                Enfermería Nefrológica
                Enferm Nefrol
                Sociedad Española de Enfermería Nefrológica (Madrid, Madrid, Spain )
                2254-2884
                2255-3517
                September 2022
                : 25
                : 3
                : 201-202
                Affiliations
                [4] orgnameSociedad Española de Nefrología España
                [2] orgnameGrupo Multidisciplinar de Acceso Vascular de España España
                [5] orgnameFundación Española de Diálisis España
                [1] Barcelona orgnameFundación Sanitària Mollet orgdiv1Servicio de Nefrología orgdiv2Hospital Universitari Mollet España
                [3] orgnameVascular Access Society España
                Article
                S2254-28842022000300001 S2254-2884(22)02500300001
                10.37551/52254-28842022020
                f4a244a9-3dd9-44a3-aa31-9efb53e517fb

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 9, Pages: 2
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                SciELO Spain

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                Editorial

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