Risk of severe blood loss from vascular access for haemodialysis

Haemodialysis vascular access by its nature has a high blood flow rate under high pressure. Therefore, when the integrity of the vascular access is compromised, severe blood loss can occur. There have been a number of incidents reported where blood loss from the vascular access has led to severe harm or death of patients. This issue has previously been highlighted to renal units via alerts from RA-BRS Patient Safety.

Blood loss has occurred from arterio-venous fistulae, arterio-venous grafts and tunnelled central venous catheters. Often, but not always, the vascular access is not in use at the time of the blood loss and blood loss that occurs outside of the hospital is often more difficult to control.


As this continues to be a significant risk, RA-BRS Patient Safety would be interested to know details of blood loss incidents and what actions units have implemented or recommend to reduce this risk. This is part of a joint project with the BRS Vascular Access Special Interest Group.

In particular, we would like to know:

  • How many incidents of blood loss from vascular access have occurred in the last year
    and the causes.
  • If units recommend / supply tourniquets to patients for severe bleeding from
    arteriovenous fistulae or grafts
  • What information units provide their patients on potential blood loss from their vascular
  • What training is provided to nursing haemodialysis staff on blood from the vascular
  • Whether any training is provided to other departments, professions and the ambulance
    service about this risk

All occurrences of blood loss should also be reported as incidents through the hospital reporting system.
Please submit comments, solutions, and personal experience to:
Katie Fielding, RA-BRS Renal Nurse Patient Safety Lead and Chair, BRS Vascular Access Special Interest Group
Dr. Paul Rylance, RA-BRS Patient Safety Lead