Refresher course


This Refresher Course is designed as part of the continuous education of those who have previously completed the In-depth Course. In this part of the Educational Programme we will go through the following:

  • Background
  • Risk Factors
  • Managing the risk of VND
  • Take home messages


The VND incidences are on the rise.

Risk factor

Patients sleeping while on dialysis are less likely to notice a VND.

Step 1 – Venous pressure alarms

Venous pressure alarms MAY be triggered after a VND event, but should not be relied upon.

Alarm windows should be set as close to the venous pressure as possible without triggering false alarms.

Asymmetric windows make it easier to avoid false alarms at the high pressure side.

Step 2 – Risk assessment

Healthcare professionals are constantly making risk assessments. Knowing the important risk factors can help highlight cases with a high risk of VND and trigger a suitable response. For individual patients, risk assessment tools have been developed to help aid risk management decisions.

Step 3 – Education and awareness

Education and awareness are possibly the most important tools in managing the risk of VND.

Education should be provided for healthcare professionals and patients and should be renewed at intervals. A transparent culture should prevail where VND incidents are reported and discussed.

Step 4 – Securing needle sites

A consistent policy should be in place for securing needles. Chevron or butterfly techniques are advocated.

Caution should be given to excessive sweat, hair or small blood losses which may obstruct good fixation.


Step 5 – Blood loss detection devices

High risk patients or environments – such as home or nocturnal haemodialysis – may benefit from medical devices which are much better at detecting VND events than venous pressure alarms.

Take home messages

ALL patients are at risk of VND: it is important not to become complacent.

Report VND incidents and promote a blame-free working environment.

Continuous education and raising awareness of VND are key to minimising risk.

Individual risk assessments can highlight patients at risk who may benefit from extra monitoring.