Dialysis Needle Dislodgement, Other Safety Problems Plague Clinics

A new ProPublica investigation is shining a harsh light on <"http://www.yourlawyer.com/topics/overview/Dialysis-Needle-Dislodgement-Hemodialysis-Blood-Tube-Hemorrhaging-Bleeding-Lawyers-Lawsuit-Attorney">dialysis clinics throughout the US. According to the piece, the US has the worst death rate among <"http://www.yourlawyer.com/topics/overview/Dialysis-Needle-Dislodgement-Hemodialysis-Blood-Tube-Hemorrhaging-Bleeding-Lawyers-Lawsuit-Attorney">dialysis patients in the world, with one in five patients dying each year. That’s double the rate of countries with the best dialysis outcomes, ProPublica said.

One of the major causes of dialysis death and injury is hemorrhaging as a result of needle dislodgement. In a typical treatment, a technician attaches the patient to the dialysis machine by inserting two needles into the patient’s access point. Each needle is attached to a tube, one of which carries the patient’s blood into a filter called a dialyzer. The other tube returns the clean blood.

According to ProPublica, dialysis machines can now cycle patients’ blood at a rate of 300 milliliters to 500 milliliters per minute, making dislodgements more dangerous than in earlier eras when treatments were done more slowly. One nurse told ProPublica that needle dislodgement during dialysis is akin to “turning up the pressure on your garden hose.” In some cases, significant blood loss can occur in less than 10 minutes.

Such occurrences are largely preventable. But in dozens of cases in which patients suffered such harm, government inspection records show, regulators later cited clinics for failing to adhere to minimum standards of care, ProPublica said.

ProPublica’s examination of inspection records for more than 1,500 clinics in California, New York, North Carolina, Ohio, Pennsylvania and Texas from 2002 to 2009 found at least one fatality resulting from needle dislodgements in each state during this period, plus dozens of additional cases in which patients required hospitalization, blood transfusions or other emergency interventions.

According to ProPublica, only a handful of states, including Colorado, Georgia, New York and Tennessee, mandate that dialysis units report incidents resulting in unexpected patient deaths or injuries. Some healthcare workers told ProPublica that that bleeding incidents sometimes aren’t reported, particularly if patients do not need to be transferred to a hospital.

Unpublished government cause-of-death data reviewed by ProPublica confirms that treatment-related bleeds kill patients each year: From 2006 to 2008, facilities gave “hemorrhage from dialysis circuit” as the primary cause of death for 18 patients and as a secondary cause for six more.

ProPublica’s review of inspection records obtained via Freedom of Information Act requests from the Center for Medicare and Medicaid Services (CMS) also uncovered other problems at US dialysis clinics. In nearly half of the units, inspectors noted dirty or unsafe conditions, including dried blood in treatment chairs or on walls, floors, and ceilings. Hundreds of clinics were cited for lapses in infection control, and dozens more for prescription errors. In many cases, staff at dialysis centers were monitoring more than the recommended number of patients. Almost none have doctors on the premises and some do not even have a registered nurse. While clinics are supposed to be inspected every three years, records showed some had gone for more than five years without a thorough review.

According to ProPublica, kidney dialysis became common in the US as a result of a 1972 law that mandated Medicare coverage for almost all patients who depended on the procedure. Close to 400,000 Americans receive dialysis, with most undergoing three treatments per week at outpatient clinics. Medicare has long favored large companies because of their ability to hold down the cost of dialysis. As a result, almost two-thirds of US dialysis clinics are now owned by one of two companies, Fresenius Medical Care North America, a subsidiary of a German medical supply company, and DaVita Inc. in Denver. Each has at least 1,500 clinics and more than 120,000 patients. No other operator in the US has more than 300 clinics.

Unfortunately, for dialysis patients, safety information on clinics has been hard to come by. While CMS has a Dialysis Facility Compare tool on its website, it does not contain detailed quality data, ProPublica said. Interestingly, just days before ProPublica published its investigation, CMS decided to release all of the data.

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