Abstract
Post-procedural wound haemorrhage is a potentially life-threatening complication. For haemodialysis patients, bleeding is often encountered after vascular access procedures and fatal episodes have been reported. Visual monitoring for bleeding is manpower intensive and bleeding episodes may still be missed between inspections. A device, Blood WArning Technology with Continuous Haemoglobin sensor (BWATCH), was developed to detect bleeding from wounds. This a prospective, observational clinical trial on patients who have had a dialysis catheter inserted or removed. The battery-powered, disc-shaped device (43 mm diameter, 12 mm height) was placed over the dressing for at least six hours. The device detects reflected light with characteristics specific for haemoglobin and an alarm would be triggered if bleeding occurs. There were 250 participants (177 post-insertion, 73 post-removal) and 36 episodes of bleeding occurred. The device alarm was triggered in all instances but there were also 9 false alarms. Specificity was 95.8%, false positive rate was 4.2% and positive predictive value was 80.0%. Sensitivity and negative predictive value were 100% but detection failure may still occur due to improper application or device maintenance. The use of technological aids for monitoring improves patient safety and may reduce demand on manpower.
Highlights
Post-procedural wound haemorrhage is a potentially life-threatening complication
In the setting of haemodialysis, with multiple repeated vascular access procedures performed on uremic patients prone to bleeding[2], post-procedural bleeding may be even more common
The UK Renal Association, British Renal Society and Intensive Care Society subsequently released a recommendation for the safe removal of a temporary femoral dialysis line in 2 0195
Summary
Post-procedural wound haemorrhage is a potentially life-threatening complication. For haemodialysis patients, bleeding is often encountered after vascular access procedures and fatal episodes have been reported. A device, Blood WArning Technology with Continuous Haemoglobin sensor (BWATCH), was developed to detect bleeding from wounds This a prospective, observational clinical trial on patients who have had a dialysis catheter inserted or removed. Despite care taken to mitigate the risks, bleeding complications inevitably occur with varying degrees of severity While data on such complications are rarely available in public domain, a published audit noted a post-operative bleeding rate of 6.3%1. A few years ago, through personal communications, a few incidents of catastrophic bleeding following removal of vascular dialysis catheters were flagged up for review Published literature on this complication was scant. The most comprehensive report in public domain came from the British National Reporting and Learning System, with 6 incidents of late bleeding following femoral line removal documented over 3 years Of these incidents, 3 resulted in deaths and 2 suffered more than one litre of blood loss[4]. Delegating monitoring tasks to attendants may not be safe or permitted in many jurisdictions, especially when the potential risk of a missed bleeding episode is death
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