Dr Evelyn Perry1,2, A/Prof Kevan Polkinghorne4,5, Ms Ashima Abbott4, Ms Mechelle Seneviratne4, Prof Matthew Jose2,3
1Barwon Health, , Australia, 2Royal Hobart Hospital, , Australia, 3School of Medicine, University of Tasmania, , Australia, 4Monash Health , , Australia, 5Monash University, , Australia
Biography:
Evelyn is a first-year renal advanced trainee working at the Royal Hobart Hospital. She has an interest in general nephrology and renal genetics.
Aim:
To investigate the circumstances and contributing factors in fatal vascular access haemorrhage (FVAH).
Background:
FVAH remains a rare but preventable cause of death. Understanding the factors surroundings FVAH events can assist Nephrology units in developing preventative strategies.
Methods:
From 2014 to 2023, all cases of FVAH (N=43) were identified using the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). Using ANZDATA as an intermediary to ensure anonymity, Nephrology units were surveyed to ascertain clinical information including location, patient and unit response factors surrounding each FVAH.
Results:
22 survey responses were received (51% response rate). Six deaths were coded incorrectly. Median age was 65, 25 (60%) were women. Detailed information on 14 confirmed FVAH individual cases was returned. Eight (57%) occurred at home, six (43%) in hospital or in an ambulance. Eight (57%) and two (14%) patients were on antiplatelet or anticoagulation therapy respectively. Five (36%) had a preceding herald bleed. Nine arteriovenous fistulas (AVFs) (64%) had poor skin integrity, two (14%) had recent infection and two (14%) were severely aneurysmal. Five AVFs (36%) had known venous stenosis awaiting vascular review/intervention. Three AVFs (21%) were not in use at the time of death (2 transplant). Two patients (14%) were on home HD at the time of death. Practice changes instituted in response included education of staff and patients and institution of regular AVF surveillance programs especially after kidney transplant. New policies included same-day vascular surgical review for AVF/AVG with infection or discoloured skin.
Conclusion:
FVAH are preventable. Understanding the circumstances and risk factors for each event through prospective data collection will assist unit in developing preventative strategies for this rare but fatal complication.