Needle Dislodgement Research Articles

Automation and innovation in home hemodialysis machines.

In this review, we discuss the timeline of innovation and technologic development in home hemodialysis (HHD) in the United States and the legislative approvals that accompanied them. The most recently FDA-approved home hemodialysis devices provide features that include on-demand and batch dialysate generation, access disconnect for venous needle dislodgement, touchscreen interface with visual and auditory prompts and animations, drop-in sterilized cartridges with prestrung tubing, hot water disinfection of tubing allowing extended-use, dialysate flow rates as high as 500 ml/min, as well as remote treatment monitoring capabilities. Furthermore, wearable/portable dialysis devices are currently under development to simplify dialysis delivery to patients with end-stage kidney disease. Home hemodialysis devices providing longitudinal hemodialysis across different clinical settings, virtual reality headsets for more personalized training, automated patient support, as well as wearable device development and innovations give hope for a future where home hemodialysis is more accessible and seamless.

Automatic Detection System for Needle Dislodgement During Blood Purification Therapy

Automatic Detection System for Needle Dislodgement During Blood Purification Therapy

Detection of Hemodialysis Venous Needle Dislodgment Using Venous Access Pressure Measurements: A Simulation Study.

In rare instances, hemodialysis venous needles may become dislodged, and when left undetected can lead to severe injury or death. Although dialysis machines have alarms to detect venous needle dislodgment, their range of detection is limited. An understanding of the clinical conditions that may lead to missed needle dislodgments is needed for development of more robust detection systems. We created a sham dialysis circuit with a Fresenius 2008 K dialysis machine for in vitro simulation testing of machine alarm behavior under variable conditions. The circuit used a blood substitute and mimicked a patient's venous access site. We varied blood flow rate, venous pressure, and upward drift in venous pressure and analyzed the time to alarm for the machine and an improved alarm algorithm. We also performed a cross-sectional retrospective study to identify the clinical occurrence of venous pressure upward drift between September 1, 2016, and November 1, 2016 in patients on hemodialysis with an arteriovenous fistula. Of 43,390 venous pressure readings for 147 patients on hemodialysis, 16,594 (38%) showed an upward drift in venous pressure (range 20-79 mmHg), with a mean ± SD increase of 11±18 mmHg within 20±14 minutes. A total of 19 venous needle dislodgment simulations under different venous pressure and blood flow parameters resulted in 19 (100%) algorithm alarm activations. Only 8 simulations (42%) activated a machine alarm, and machine alarm activation time was longer than the algorithm activation time for all 8 machine alarms (range 1-13 seconds). Patients can experience changes in venous pressure during hemodialysis which may not trigger a machine alarm in the case of a venous needle dislodgment. Our simulations showed that current dialysis machine alarm systems may not compensate for upward drift in venous pressure, and improved algorithms for detecting needle dislodgment during hemodialysis are needed.

A system for preventing internal fistula needle dislodgement: Delphi study and pilot evaluation.

To establish a scoring system for risk assessment (SSRA) for internal fistula needle dislodgement (IND) in hemodialysis (HD) patients. The SSRA was constructed based on literature search, medical history review, expert consultations, expert meeting (Delphi study), and analytic hierarchy process. Then, a pilot test was conducted at our hospital between August 1, 2020, and July 30, 2021. Consecutive patients requiring HD were included and randomly assigned to experimental and control groups (1:1 ratio). Control group was treated with the routine procedures, while the experimental group was treated with strengthened nursing measures based on the individual risk assessed by SSRA. Finally, the incidence of IND was compared between the two groups. For the Delphi study, 16 experts in dialysis nursing in Zhejiang, Shanghai, Guangzhou, and Qinghai were included. The final draft of the SSRA included three first-level indices, 11 second-level indices, and 26 third-level indices. A total of 218 HD patients were included. The IND rate in the experimental group was significantly lower than that in the control group (p < .01). We established a scientific, reliable, and feasible SSRA for timely identification of HD patients with high risk of IND and the corresponding nursing procedures to prevent IND.

Reducing the Risks of Home Dialysis Innovation and Uptake: The Case for Human-Centered Product Design.

Reducing the Risks of Home Dialysis Innovation and Uptake: The Case for Human-Centered Product Design.

The development and testing of a prototype venous needle dislodgement detection device.

Inadvertent venous needle dislodgement (VND), from graft or arterio-venular fistula, can lead to haemorrhage resulting in a serious life-threatening complication and in some cases death by exsanguination. This paper eloquently articulates the development and testing of a novel Arduino based VND detection device. The VND detector is subjected to four testing protocols to critically analyse the efficiency of VND detection within a 12-second window. Implementation of statistical analytic methods to the obtained results successfully demonstrated the VND detector's ability to detect VND within 12 seconds.

MO607: Intradialytic Exercise: A Large-Scale Nationwide Implementation Study

Abstract BACKGROUND AND AIMS Intradialytic exercise (IDE) is recommended for HD patients. However, this recommendation is mostly based on research conducted under optimal instead of real-world conditions, limiting generalizability and its implementation into routine clinical care. This study aims to analyze implementation outcomes of IDE in real-world conditions at a large-scale, nationwide level. METHOD After a pilot experience in a single unit, all NephroCare Portugal dialysis clinics were invited to initiate an IDE program. A national coordinator was nominated, and a nurse and a doctor were selected in each unit as local coordinators. A simple exercise protocol was designed to be easily applied by current dialysis staff (though some units benefited from exercise science student internships). The IDE protocol includes a bout of aerobic exercise (cycle ergometer) and lower limb resistance exercises (ankle weights). The RE-AIM (reach, effectiveness, adoption, implementation and maintenance) framework was used to study clinical implementation over the first year. For each RE-AIM dimension, specific implementation outcomes were adapted to IDE. Effectiveness measures included safety (incidence of intradialytic adverse events over 1 year) and physical function at baseline and at 1 year (sit to stand 30, 8-foot up &amp; go, handgrip strength, sit to stand 5 and single leg stance). For safety measures, IDE group was compared to a group of patients that refused IDE. Physical function measures were only applied to IDE patients, and so comparisons were made between low- and high-frequency exercise groups. RESULTS Adoption: 21 dialysis units (58.3%). Reach: 1270 eligible patients (55.8%). Main reasons for noneligibility were physical/cognitive incapacity (50.8%) and cardiovascular risk (34.9%). Eligible patients were younger (P &amp;lt; 0.001) and had a better health status (lower comorbidity index: P &amp;lt; 0.001; lower prevalence of diabetes: P &amp;lt; 0.001; lower fat tissue index: P &amp;lt; 0.001; and a higher lean tissue index: P &amp;lt; 0.001). 811 (63.9%) committed to the intervention. Compared with non-IDE patients, IDE patients were younger (&amp;lt;0.001), had a lower dialysis vintage (&amp;lt;0.001), a lower comorbidity index (P &amp;lt; 0.001) and a higher lean tissue index (P = 0.035). Implementation: adherence to exercise sessions was 75.0% ± 19.7%. In 77% of the 50 356 HD treatments, exercise was performed as prescribed. Non-performed exercise sessions (n = 9768) are mostly justified by patient refusal (61.5%) and pain (8.4%). Patients performed 2.2 ± 0.6 exercise sessions/week achieving 86.3 ± 29.0 min/week. Maintenance (setting level): none of the clinics interrupted IDE. Maintenance (patient level): attrition rate was 57.2% mainly due to voluntary withdrawal (52.4%). Comparing to voluntary withdrawals, completers were mainly males (P &amp;lt; 0.001) and had a lower dialysis vintage (P = 0.007), and higher lean tissue index (P = 0.023). Effectiveness: IDE (n = 347) and non-IDE patients (n = 394) were compared. Total incidence of adverse events was lower in IDE, but no significant differences were found (P = 0.808). The individual analysis of each adverse event demonstrated no significant differences for cramps, hypotension, needle dislodgement and other adverse events. Overall physical function improved in IDE (P &amp;lt; 0.001), despite a slight reduction in handgrip strength (P = 0.001). A within-group (low- versus high-frequency exercise) effect was observed, highlighting a deterioration in handgrip strength in the low-frequency group (P = 0.002), whereas no change was observed in the high-frequency group (P = 0.097). CONCLUSION Large-scale implementation of IDE is a realistic and safe way to promote physical activity in HD patients with benefits on physical function. Yet, to optimize its generalizability, strategies to increase patients´ acceptability and long-term adherence are needed.

Real-Time Internet of Medical Things System for Detecting Blood Leakage during Hemodialysis Using a Novel Multiple Concentric Ring Sensor.

Venous needle dislodgement (VND) is a major healthcare safety concern in patients undergoing hemodialysis. Although VND is uncommon, it can be life-threatening. The main objective of this study was to implement a real-time multi-bed monitoring system for VND by combining a novel leakage-detection device and IoMT (Internet of Medical Things) technology. The core of the system, the Acusense IoMT platform, consisted of a novel leakage-detection patch comprised of multiple concentric rings to detect blood leakage and quantify the leaked volume. The performance of the leakage-detection system was evaluated on a prosthetic arm and clinical study. Patients with a high risk of blood leakage were recruited as candidates. The system was set up in a hospital, and the subjects were monitored for 2 months. During the pre-clinical simulation experiment, the system could detect blood leakage volumes from 0.3 to 0.9 mL. During the test of the IoMT system, the overall success rate of tests was 100%, with no lost data packets. A total of 701 dialysis sessions were analyzed, and the accuracy and sensitivity were 99.7% and 90.9%, respectively. Evaluation questionnaires showed that the use of the system after training changed attitudes and reduced worry of the nursing staff. Our results show the feasibility of using a novel detector combined with an IoMT system to automatically monitor multi-bed blood leakage. The innovative concentric-circle design could more precisely control the warning blood-leakage threshold in any direction to achieve clinical cost-effectiveness. The system reduced the load on medical staff and improved patient safety. In the future, it could also be applied to home hemodialysis for telemedicine during the era of COVID-19.

Needle dislodgement in hemodialysis patients: Progress in prevention and early intervention.

Needle dislodgement during hemodialysis is a potentially lethal accident that, although rare, has yet to be completely eliminated in clinical dialysis. Fatal hemorrhaging can occur with the loss of proper needle positioning due to the continuously running pump of the dialysis machine. Cooperative efforts by medical professionals, scientists, and related industries have been made to remove all such risks. In this review, we highlight the recommended practices summarized by professional associations and recent progress regarding the research and development of auxiliary equipment for dialysis nursing aimed at preventing and/or providing early intervention for needle dislodgement.

Quality Assurance and Preventing Serious Adverse Events in the Home Hemodialysis Setting.

Patient safety is of the utmost importance in home hemodialysis (HHD). Recognizing that there are risks related to vascular access (both infectious and noninfectious events), dialysis water quality, and procedural-related adverse events (including arteriovenous fistula needle dislodgement or air embolism), there is a need for systematic identification and management. Although adverse events are relatively infrequent in HHD, the potential consequences of these events may include significant morbidity, HHD treatment failure, or death. Therefore, having a systematic framework to review each event, audit and retrain patient technique, disclose and discuss events with patients, home unit staff and device companies (if relevant) and determine preventative measures to avoid future adverse events, is crucial. In this review, we will describe the literature around the types and relative frequency of serious adverse events in the HHD setting and we will outline a quality assurance framework for capturing, managing, and avoiding serious adverse events. Finally, we will describe some of the novel existing approaches to preventing or addressing serious adverse events and critical knowledge gaps that should be evaluated in future study.

Venous Needle Dislodgement and Access-Bloodline Separation

Serious hemodialysis therapy complications are venous needle dislodgement and access-bloodline separation. In 2020, the American Nephrology Nurses Association (ANNA) brought together a task force to update the information and resources developed by the 2012 ANNA Venous Needle Dislodgement Task Force along with the development of additional resources, if needed. The 2020-2021 ANNA Venous Needle Dislodgement Task Force conducted a literature review, requested information from ANNA members, and tested taping techniques. This article discusses the results of the literature review, information requests, and taping technique testing, and provides resources on venous needle dislodgement and access-bloodline dislodgement, along with practice recommendations.

Hemodialysis taping styles and their effect on reducing the chance of venous needle dislodgement.

Vascular access complications are common among hemodialysis patients, although most are not immediately life-threatening. However, inconsistent taping techniques and incompatible detection mechanisms may lead to venous needle dislodgement (VND), which can lead to catastrophic blood loss. Taping technique does not always meet the recommended best practice and there may be no available protocol for new staff. Three commonly used taping patterns (the Chevron, butterfly, and overlapping styles) were tested in a mechanical engineering laboratory to determine the forces that each method was capable of withstanding. While all taping styles were confirmed to have an adhesive force stronger than the inherent force from the venous jet flow of blood, the overlapping style was found to have limited capability beyond this minimum criterion. Both the butterfly and Chevron styles demonstrated excellent holding capability, with elongation of dislodgement particularly noted for the butterfly style, and slightly stronger hold noted for the Chevron style. The Chevron style may be better suited to lateral movements from all directions, due to the taping direction. We recommend that either the Chevron or butterfly style is used for dialysis needle taping, with the butterfly better suited to home dialysis (where monitors may be used) and the Chevron better suited for in-care patients who may present erratic movements. The overlapping style is not recommended for use.

The Integrated Program of Needle Dislodgement Bleeding Alarm System Is Associated with a Decreased Incident of Venous Needle Dislodgement or Bleeding

The Integrated Program of Needle Dislodgement Bleeding Alarm System Is Associated with a Decreased Incident of Venous Needle Dislodgement or Bleeding

P1563THE ANALYSIS OF RISK FACTORS FOR THE PATIENTS EXPERIENCED VENOUS NEEDLE DISLODGEMENT OR BLEEDING DURING DIALYSIS

Abstract Background and Aims A puncture of vascular access is commonly used in clinical treatment, such as hemodialysis or central venous catheters. At this time, leakage or infection associated with Venous needle dislodgement(VND) is a high risk of fatality, especially for patients with restlessness, impaired cognition, isolation, or home dialysis. At present, a few studies believe that many risk factors are associated with venous needle dislodgment and bleeding, including difficult needle fixation, restlessness, unconsciousness, or abnormal movement. However, only a few studies are focusing on patient disease, medication, and other risk assessments. Therefore, this study aims to explore the risk factors of patients with venous needle dislodgment and bleeding and hope to establish the risk classification. Method This study was a prospective study conducted in the hemodialysis room of Tainan Regional Hospital. Before starting to collect the venous needle dislodgment and bleeding data, we performed a training program for medical and nursing staff, including venous puncture, fixation, puncture site assessment, and management. During the three months from July 2019 to 2019/9, we collected clinical data were collected, including patient sex, gender, diseases, records of dialysis access blockage, anticoagulant dose, and a high-risk assessment record (eight risk factors). Finally, we analyzed the data and compared the data between the two groups of patients who experienced needle dislodgement and bleeding. We applied statistical software STATA, chi_square, z-test. P&amp;lt;0.05 was defined as significant. Results Seventy patients were included in this study, with an average age of 63.23 (± 1.2 years) and 45 males (64.28%). In 2019 / 7-9, there were a total of 32 patients with 72 venous needle dislodgment and bleeding. The patients with the condition as below were considered high-risk patients. In terms of gender, whether it is a high risk, diabetes, high blood pressure, whether to use sleeping pills, diabetic hypotension, whether to use warfarin or to use anticoagulant doses are all not statistically significant. The proportion of patients with vascular-access and undergoing percutaneous transluminal angioplasty was 35.2% (11) in high-risk patients and 10.3% (4) in low-risk patients, p &amp;lt;0.01. Conclusion Before data collection in this study, a standardized training program was performed for medical care and vascular access monitoring. However, there were no new risk factors were found. This research model can provide a new direction for further research.

P1562IMPLEMENTATION FOR INTEGRATED PROGRAM OF HEMODIALYSIS VASCULAR ACCESS PUNCTURE TRAINING AND AN ALARM SYSTEM MAY REDUCE THE INCIDENT OF VENOUS NEEDLE DISLODGMENT AND BLEEDING

Abstract Background and Aims A puncture of vascular access is commonly used in clinical treatment, such as hemodialysis or central venous catheters. At this time, leakage or infection associated with Venous needle dislodgement(VND) is a high risk of fatality, especially for patients with restlessness, impaired cognition, isolation, or home dialysis. In general dialysis procedures, medical personnel relies on patient reports and caregivers to manually inspect the site of dialysis puncture and detect the occurrence of needle removal and blood transfusion. There are some devices for detecting the presence of needle dislodgement in the market. Still, there are no large-scale reports for the integrated program for nursing training and device implantation. This study aims to conduct a program for an integrated training course and the VND device and hopes to reduce the incidence of needle removal and blood leakage. Method This study was divided into two phases, the control phase, and the study period. In the first phase, the abnormal events of ou venous needle dislodgement and blood leakage was recorded in the hemodialysis unit room during the first three months. Before the study period, we introduced an integrated program, including the standard process of fistula puncture, care during hemodialysis, an inspection of the venous puncture site, and an alarm system. In the study period, we also conducted the standard program and collected the data of the events of venous dislodgement or bleeding. Results The control phase was conducted during the three months from July 2019 to September 2019, and the study period was performed in November 2019. A total of 62 patients completed the study. During the control period, there were a total of 2087 dialysis treatments, of which 30 patients had venous needle dislodgement or bleeding. There were a total of 70 events of venous needle dislodgement or bleeding occurred, and the incidence rate was 3.3 events per 100 sessions. After the conduction of the integrated program and implantation of the alarm system in November 2019, there were a total of 682 dialysis sessions, and 15 events of venous needle dislodgement or bleeding occurred. The incidence rate was 2.2 events per 100 courses. Conclusion This study introduced venous needle dislodgement or bleeding alarm system in the hemodialysis unit. Compared with the traditional method, after the integrated care program, including fistula puncture, care, inspection, introduction, and use of the alarm system, venous needle dislodgement or bleeding dropped from 3.3 to 2.2 per 100 sessions. Therefore, through standardized training and program, it may be related to the decrease in the incidence of venous needle dislodgement or bleeding. This training mode can be worth promoting to more dialysis units to improve the quality of patient care. More follow-up studies are needed to provide multiple evidence.

P1554TYPES OF INCIDENTS MANAGED AT TWO DIFFERENT MEDICAL LEVELS IN A LARGE MULTINATIONAL RENAL SERVICES PROVIDER NETWORK

Abstract Background and Aims Patient safety programs need a well-structured organization to facilitate proactive and fair reporting, prompt evaluation analysis and timely feedback followed by measure implementation and auditing. To analyze all types of incidents in our network from Jan.1st to Sept. 30th, 2019 by two different levels (Corporate and Country) of medical management alert. Method Our institution has tracked all incidents under a structured process program for the last 10 years, according to 4 incident types (Patient related, Staff-visitors, Products and Equipment) and 54 subcodes. Incidents are considered as serious when they may be life-threatening or result in death, impaired body function/structure and/or are deemed serious based on appropriate medical judgment. Communication to Health Authorities applies in accordance with local country regulations. “Serious incidents” are immediately notified to the Corporate Office and to each Country Medical lead, whilst different codes may generate alerts into Corporate or Country. Results A total of 68.399 incidents (2.7 incident/patient/year) were reported during Q1-Q3 2019. Total incidents/1000 treatments were 17.1 (12.1 were patients related incidents). Causes for alerts at corporate level (n=65) were: cardiorespiratory arrest (28%); unexpected death (15%); seroconversion (9%); hemolysis (8%), severe hypotension (6%) and air embolism (3%). Reported incidents at country level (n=655) were almost half ascribed to equipment [water supply, power failure and flooding (41%)], medication errors (36%), venous needle dislodgment (19%) and Injuries (3%). Conclusion Despite continuous efforts to get better results, there is room for improvement on better staff compliance with our standard operating procedures especially regarding medications and venous needle dislodgment risk assessment.

P1559PERFORMANCE EVALUATION OF REAL-TIME MULTI-BED MONITORING SYSTEM FOR BLOOD LEAKAGE IN DIALYSIS

Abstract Background and Aims In HD treatment, venous needle dislodgement (VND) is a major concern in healthcare systems worldwide. Although VND is not an extremely common occurrence, it could be life-threatening or even cause death. The report of the Taiwan Patient Safety Reporting System listed the dislodgement of needles, catheters, and similar devices as third among thirteen common incident types that threaten patient safety. Hospitals are jointly liable for the blood leakage and have to provide emergency treatment such as emergency hemostasis, blood transfusion, Erythropoietin (EPO) injection and hospitalization. To a worse extent, hospitals, physicians and paramedics have to face criminal charges and the claims raised by the patients’ families. This study employed digital technology to develop a real-time multi-bed monitoring system to detect fluid leakage and control the state of multi-bed blood leakage simultaneously, allowing paramedics to respond to and solve issues swiftly. The research evaluated the IoT system for the leakage detector system with multi-bed monitoring interface by clinical trials. Method Our research used the Acusense IoT platform, which is a multi-bed monitoring system that includes leakage detection device, IoT gateway, and cloud analysis system to monitor multiple HD patients in real-time. Any single IoT gateway can be utilized to pair with eight blood leakage detection devices and collects data with multi-point Bluetooth 4.2, and the information gathered by IoT gateway will be uploaded to database via WiFi. The selecting criteria for participants, who has low risk of blood leakage and the participants who did not have blood leakage within two months, were all excluded from our analysis. Before a clinical trial, 20 nurses were trained to use the leakage detection system for two times. And then we have set this platform on different areas for 1 month. For the results of blood leakage detection system in the clinical settings, we calculated accuracy, recall, precision, and averaged F score, which are the most common metrics for evaluating the performance of binary classification. Results In this study, a total of 50 subjects with an average age and standard deviation (SD) of 62.2 and 9.1 were recruited from the Tainan Municipal An-Nan Hospital (TMANH) in Taiwan. After deploying Acusense IoT platform in clinical workflow, there were a total of 682 dialysis sessions and 15 events of venous needle dislodgement or bleeding occurred of which 13 were detected by the device. The performance metrics reach 99.7% accuracy, 100% recall, 99.7% precision, and 99.9% Averaged F-measure. There are no adverse reactions to patients. It indicates that the proposed blood leakage detection system showed favorable performance, and was proven to be capable of accurately detecting blood leakage. Conclusion The blood leakage detector combined with information system realizes the multi-bed monitoring system and provides support for real-time clinical decision support system. When venous needle dislodgement happens, the monitoring system will timely warn nurse to increase the relationship between doctors and patients. It may result in the prevention of VND, and decreased hospitalization to reduce the side effects of hemodialysis.

Detection of Needle Dislodgement Using Extracorporeal Pressure Signals: A Feasibility Study.

Venous needle dislodgement (VND) during dialysis is a rarely occurring adverse event, which becomes life-threatening if not handled promptly. Because the standard venous pressure alarm, implemented in most dialysis machines, has low sensitivity, a novel approach using extracted cardiac information to detect needle dislodgement is proposed. Four features are extracted from the arterial and venous pressure signals of the dialysis machine, characterizing the mean venous pressure, the venous cardiac pulse pressure, the time delay, and the correlation between the two pressure signals. The features serve as input to a support vector machine (SVM), which determines whether dislodgement has occurred. The SVM is first trained on a set of laboratory data, and then tested on another set of laboratory data as well as on a small data set from clinical hemodialysis sessions. The results show that dislodgement can be detected after 12-17 s, corresponding to 24-143 ml blood loss. The standard venous pressure alarm used in clinical routine only detects 50% of the VNDs, whereas the novel method detects all VNDs and has a false alarm rate of 0.12 per hour, provided that the amplitude of the extracted cardiac pressure signal exceeds 1 mmHg. The results are promising; however, the method needs to be tested on a larger set of clinical data to better establish its performance.

A prototype line clamp for venous access bleeding in hemodialysis: A prospective cohort study.

Venous needle dislodgement (or venous port disconnection) during hemodialysis (HD) may lead to catastrophic blood loss, particularly during unsupervised home HD. A prototype venous line clamp was developed for use in conjunction with the Redsense blood loss sensor. We hypothesize that this prototype device will provide additional safety to dialysis without excessive burden. This was a single-center, prospective cohort study. Participants kept a log of bleeding, troubleshooting and clamp deployment events, and completed questionnaires before device first use and after device final use. The primary outcome was appropriate device function, evaluated by review of bleeding and clamp deployment events. The secondary outcomes were patient/nursing staff expectations and experience of the device. Fourteen patients used the device during a combined total of 214 HD treatments. Five participants (36%) had experienced a bleeding or disconnection event prior to study recruitment. All vascular access types were represented. The device was tested during incenter HD (n = 7 patients) and home HD (n = 7 patients). There were eight clamp deployment events, three of which were in the setting of minor bleeding at the venous access site. No other bleeding events were reported. The main troubleshooting issues were related to cumbersome device connections. Participants perceived additional safety with the device (median score 4.25 out of 5; range 1-5). However, the amount of additional work created was variable, and large in some cases (median score 2 out of 5; range 0-4.5). There was no association between HD vintage and device burden (P = 0.55). This "proof of concept" study confirmed that a clamp on the venous line, operating in conjunction with a venous access blood detector, is feasible regardless of HD location or vascular access type. The device improved patient safety perception during HD but was burdensome. Design modifications could improve future device iterations.

Development of a needle dislodgement detection system and a vascular access flow rate measurement system using electrical impedance

Development of a needle dislodgement detection system and a vascular access flow rate measurement system using electrical impedance