Post-Kidney Transplant Dialysis Leads to Internal Bleeding

Case Overview

This case study delves into an incident involving a 58-year-old patient with End-Stage Renal Disease (ESRD) who was on Hemodialysis (HD). The individual, listed for a kidney transplant, received a donor kidney. However, HD had to be restarted shortly after the procedure due to complications.

During one of the dialysis sessions, the nurse encountered difficulty locating a patent vessel in the upper extremity for line placement. As a result, she successfully placed the line in the femoral/groin area.

Unfortunately, it was later discovered that an upper extremity vein had been inadvertently nicked during the initial attempt. This error led to internal bleeding and necessitated four months of hospitalization.

The case seeks an expert opinion from a nephrologist to review the medical records, and opine as to the standard of care, causation, and damages.

Questions to the expert and their responses

How often do you evaluate and manage dialysis patients?

As a board-certified nephrologist and professor of medicine at a Midwest university, I am regularly involved in the care and management of dialysis patients as part of my practice.

What are the most pertinent measures that healthcare professionals in dialysis centers can perform to minimize misplaced IV catheters?

Temporary lines require meticulous review before use. It’s essential to ensure that there is no risk of laceration or clotting in the native vein. This could lead to severe complications such as bleeding.

Have you ever reviewed a similar case? If yes, please elaborate.

My background as a medical director in a dialysis unit, former medical director of a large kidney transplant program, and former Chief Medical Officer (CMO) of my local Organ Procurement Organization (OPO) has provided me with extensive experience and insights into issues like these.

About the expert

This expert is a seasoned nephrologist with over 30 years of experience in internal medicine and nephrology. They have an extensive academic background, including numerous publications in peer-reviewed journals, and have held significant positions such as the medical director of a kidney and pancreas transplant program and a living kidney donation program. Currently, they serve as a professor of clinical medicine at a medical school and are an active staff member at a university-affiliated medical system, bringing invaluable insights into cases involving dialysis and kidney transplantation.