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Safety Risk of Air Embolus Associated with Central Venous Catheters Used for Haemodialysis Treatment.
April 26, 2023
Farnborough, UK: Healthcare Safety Investigation Branch. March 2023.
Patients receiving hemodialysis are at risk of complications, including air embolus. This report describes how unfamiliar equipment and lack of standardized training contributed to the death of a dialysis patient due to air embolus. Safety recommendations include changes in medical education on how to handle uncertainty in clinical settings and amending dialysis guidelines to include risk of air embolus associated with unclamped central venous catheters.
