Blood loss during vascular access cannulation: quantification using the weighed gauze and drape method

Anemia is an important complication of chronic renal disease, with a significant impact on the morbidity, quality of life, and mortality in this group of patients. Inadequate erythropoietin production, reduced life span of erythrocytes in uremic serum, bone marrow suppression by uremic toxins, chronic inflammation, and contaminants in the water treatment unit are recognized etiological causes of anemia in chronic kidney disease patients. Little attention has been paid to possible contributions of small but continual loss of blood during vascular access cannulation for hemodialysis in these patients. The aim of this study is to quantify the volume of blood loss during femoral vein cannulation in patients on hemodialysis. The average volume of blood loss during femoral cannulation was evaluated using a simple and inexpensive procedure of deriving volume of blood lost, from the weights of soaked gauze and drape during the access cannulation procedure. The mean blood loss per procedure during femoral cannulation was 36.52 mL+/-2.70 SD, with a range of 6.47 to 100.20 mL. The calculated average weekly loss in patients on thrice-weekly dialysis schedule is 109.56 mL of blood, with a monthly loss of 438.24 mL. Cumulative blood loss during femoral vein cannulation appears to be significant. Its contribution in the sustenance of anemia in hemodialysis patients deserves further evaluation.