title: Adverse technical events in home hemodialysis.
abstract: BACKGROUND
  There is a growing interest in home hemodialysis because of its clinical benefits. However, given that patients are responsible for performing a complex medical procedure at home, adverse-event reporting is important to ensure patient safety. The purpose of this study was to describe adverse technical events in a large cohort of home hemodialysis patients.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  All consecutive patients undergoing home hemodialysis at a large tertiary-care center from 1999 through 2011 (last follow-up, July 2012).
  
  
  RESULTS
  Overall rate of adverse technical events and number/rate of severe adverse events (defined as those requiring intervention).
  
  
  RESULTS
  The cohort consisted of 202 patients with total follow-up of 757 patient-years. The cohort underwent a median of 5 dialysis treatments per week and 8 hours per session. 22 first adverse events and 7 recurrent events were identified. Adverse event rates were 0.049 per arteriovenous fistula access-year, 0.015 per arteriovenous graft access-year, and 0.022 per dialysis catheter access-year. Event rates per 1,000 dialysis treatments were 0.208, 0.068, and 0.087 for arteriovenous fistula, arteriovenous graft, and dialysis catheter access, respectively. Most adverse events were related to needle dislodgement (n=18) or air embolism (n=6). 8 adverse events resulted in emergency department visits and 5 required hospital admission. The rate of severe adverse events was 0.009 per patient-year of home hemodialysis and 0.038 per 1,000 dialysis treatments. Interventions included 3 blood transfusions, 2 catheter changes, 1 use of intravenous fluids, and 1 need for urgent dialysis. Attempts were made to retrain or review the technique in all patients with a first adverse event.
  
  
  CONCLUSIONS
  Events that were not severe may have been under-reported by patients.
  
  
  CONCLUSIONS
  Serious adverse technical events in home hemodialysis are relatively rare. Strategies to further prevent these events may include patient retraining and periodic vascular access technique audit.
authors.affiliation: Dalhousie University/Capital Health, Halifax, Nova Scotia. Electronic address: ktennankore@gmail.com.
authors.forename: Karthik K
authors.initials: KK
authors.lastname: Tennankore
authors.affiliation: University Health Network-Toronto General Hospital/University of Toronto, Toronto, Ontario, Canada.
authors.forename: Celine
authors.initials: C
authors.lastname: d'Gama
authors.affiliation: University Health Network-Toronto General Hospital/University of Toronto, Toronto, Ontario, Canada.
authors.forename: Rose
authors.initials: R
authors.lastname: Faratro
authors.affiliation: University Health Network-Toronto General Hospital/University of Toronto, Toronto, Ontario, Canada.
authors.forename: Stella
authors.initials: S
authors.lastname: Fung
authors.affiliation: University Health Network-Toronto General Hospital/University of Toronto, Toronto, Ontario, Canada.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Wong
authors.affiliation: University Health Network-Toronto General Hospital/University of Toronto, Toronto, Ontario, Canada.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Chan
mesh_terms: D000328:Adult; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D002170:Canada; D015331:Cohort Studies; D004618:Embolism, Air / Q000209:etiology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006437:Hemodialysis, Home / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000458:organization & administration; D011475:Prosthesis Failure / Q000209:etiology*; D058996:Quality Improvement; D012189:Retrospective Studies; D012648:Self Care / Q000009:adverse effects / Q000379:methods; D012720:Severity of Illness Index
keywords: Adverse events; adverse technical events; air embolism; arteriovenous fistula; arteriovenous graft; dialysis catheter; home hemodialysis; needle dislodgement; patient training; quality assurance; safety; technical events