When a patient’s dialysis access is clotted, a dialysis center is required to contact a surgical service to arrange for declotting. That said, clotting is a very common occurrence and not an emergency. A dialysis patient can miss up to three dialysis treatments without material consequences. In this case, a very prompt effort was initiated to have access intervention done in accordance with established standards so that the patient would not miss more than even one dialysis session. In actual practice, a patient’s clotted access on a Saturday would typically result in the patient not being declotted until Monday.
For perspective, to prevent potentially fatal consequences, a patient missing more than three dialysis treatments is required to undergo new blood work before resuming treatment. That is not required for a patient missing a mere single treatment (whether for clotted access or another reason) which, again, is a very common occurrence. In fact, along with blood loss, hypo- and hypertension, and (less commonly) loss of consciousness, a clotted dialysis access is one of the expected developments in most dialysis patients. To that end, dialysis patients are educated about these (and other) potential risks of hemodialysis treatments but accept them because the life-saving benefits of dialysis outweigh the risks.
When an access is clotted, there is no way to declot the access without vascular surgery intervention, which means through an independently operated vascular access center (or vascular surgeon). There is never a guarantee that an immediate appointment will be available, but an appointment can typically be had within 48 hours. Again, such a time frame raises no concerns at all because missing just one dialysis session is of no material consequence. As mentioned, after missing just one session new blood work is not required in order to resume treatment; that is reserved for missing three or more sessions. This patient missed just one. A clotted access is a routine, known occurrence, as is having to wait for approximately two days for vascular surgical repair.
Dialysis clotting medical expert witness specialties include nephrology, interventional radiology, vascular surgery, and hematology.