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.
Question(s) For Expert Witness
- 1. Please describe your experience working in dialysis facilities.
- 2. How do you protect patients with a scab at the port site?
Expert Witness Response E-011639
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. I am happy to discuss the steps to avoid this complication. 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.