Fatal vascular access hemorrhage: reducing the odds.

Vascular access hemorrhage is not a frequently occurring complication associated with hemodialysis fistulas and grafts, but when it occurs, it can be fatal to patients and devastating to patients' families and dialysis unit staff members. The End Stage Renal Disease Notification of Death CMS-2746 forms indicated that between the years 2000 and 2006 (the most recent national data available), there were 1654 fatal vascular access hemorrhages. Specific issues that place patients at high risk for access rupture have been identified, and some are directly related to access physical assessment and cannulation. Recognizing at-risk accesses during physical assessment and improving site selection for needle placement can modify some risk factors for fatal vascular access hemorrhage and improve patient outcomes.