Defibrillation during renal dialysis: a survey of UK practice and procedural recommendations.
BACKGROUND
Defibrillation of patients connected to medical equipment that is not defibrillation proof risks ineffective defibrillation and harm to the operator as a result of aberrant electrical pathways taken by the defibrillation current. Many renal dialysis systems are not currently defibrillation proof. Although national and international safety standards caution against defibrillating under this circumstance, it appears to be an area of confusion that we have investigated in more detail.


METHODS
Thirty renal dialysis units across the UK were invited to participate in a telephone survey of current practice from 1 October 2004 to 1 October 2005. The Medical Healthcare Regulatory Agency and renal dialysis machine manufacturers were contacted for advice, and current safety standards were reviewed.


RESULTS
Twenty-eight renal dialysis units completed the survey. Seven (25%) units would not disconnect patients from dialysis equipment during defibrillation, collectively reporting 14 patients who had required defibrillation during dialysis. Eighteen (64.3%) units would disconnect patients from dialysis equipment during defibrillation, collectively reporting 29 patients who had required defibrillation during dialysis. No complications were identified by this survey, through the MHRA or through a literature search.


CONCLUSIONS
Defibrillation of patients while undergoing renal dialysis is common practice in the UK. Although no adverse events have been reported, this practice risks injury to the patient and clinical staff, and equipment damage if the dialysis equipment is not defibrillation proof. It is in breach of national and international safety standards and should not be practiced.
Bird
Scott
S
Shackleton Department of Anaesthetics, Southampton University Hospital N.H.S. Trust, Tremona Road, Southampton SO16 6YD, UK.
Petley
Graham W
GW
Deakin
Charles D
CD
Clewlow
Frank
F
D001145:Arrhythmias, Cardiac / Q000628:therapy; D004554:Electric Countershock / Q000009:adverse effects / Q000592:standards*; D006436:Hemodialysis Units, Hospital / Q000592:standards; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards; D006435:Renal Dialysis / Q000009:adverse effects*; D006113:United Kingdom