Nurse Injures Dialysis Patient's Port Causing Dangerous Bleed Out

Case Overview

This case involves a dialysis patient who developed a scab at the site of his port. Upon arriving at dialysis, the scab was recognized and acknowledged by the patient and treating staff members. The patient requested not to use adhesive tape on the site of the port scab to avoid further irritation. In spite of this request, however, the staff still used a tape on the patient.The following day, the patient’s scab fell off and the patient nearly bled to death. He required an extended hospital stay and two surgical procedures as a result. It was alleged that the dialysis nursing staff failed to adequately monitor and protect the patient’s access port, causing him further complications.

Questions to the Nursing expert and their responses

Please describe your experience working in dialysis facilities.

I have 30+ years of experience in hemodialysis and extensive experience working in acute dialysis facilities. I have trained ICU nurses and worked in hemodialysis as a charge nurse IV at a hospital. I am currently a hospital nurse working with patients with blood cancers that need stem cell transplants.

How do you protect patients with a scab at the port site?

In general, you avoid the area at all costs until it heals. You especially do not put tape on it, as it is a tenuous and sensitive area and the scab can pull off. Additionally, I perhaps would have recommended referring the patient to a vascular surgeon.

About the expert

This highly qualified nurse has 29 years of experience in hemodialysis, case management, and acute care. She has both clinical nursing experience and academic teaching experience. She has led the writing policies and protocols for renal care programs, she has led continuous renal replacement therapy classes for ICU nurses, and managed the quality of care for outpatient dialysis clinics. Formerly this expert was an RN Charge Nurse, Chronic outpatient dialysis at the Artificial Kidney Medical Clinic, and RN Acute Dialysis and Clinical Nurse at St Jospeh's Medical Center, and a Charve Nurse IV, Hemodialysis at the Methodist Hospital. Currently, this expert is a nurse at a local area hospital. She eearned her ADN at San Joaquin Delta College, her BSN at Holy Names University, and is a certified nephrology nurse.