Fatal exsanguination from hemodialysis vascular access sites

Exsanguination from hemodialysis vascular sites may cause a rapid death. Due to extensive blood loss at the scene, investigators may initially suspect a homicide or suicide. We reviewed 100 deaths due to hemorrhage from hemodialysis shunt sites. The majority (81%) of these hemorrhages occurred at ho...

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Bibliographic Details
Published in:Forensic science, medicine, and pathology medicine, and pathology, 2012-09, Vol.8 (3), p.259-262
Main Authors: Gill, James R., Storck, Kara, Kelly, Sean
Format: Article
Language:English
Subjects:
Accidents - mortality
Adult
Aged
Aged, 80 and over
Arteriovenous Shunt, Surgical - adverse effects
Arteriovenous Shunt, Surgical - mortality
Autopsy
Cardiovascular diseases
Cause of Death
Criminology and Criminal Justice
Death Certificates
Exsanguination - etiology
Exsanguination - mortality
Forensic Medicine
Forensic Pathology
Health aspects
Hemodialysis
Humans
Medicine
Medicine & Public Health
Middle Aged
New York City - epidemiology
Original Article
Pathology
Renal Dialysis
Renal Insufficiency - epidemiology
Renal Insufficiency - mortality
Renal Insufficiency - therapy
Suicide
Time Factors
Young Adult
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Summary:Exsanguination from hemodialysis vascular sites may cause a rapid death. Due to extensive blood loss at the scene, investigators may initially suspect a homicide or suicide. We reviewed 100 deaths due to hemorrhage from hemodialysis shunt sites. The majority (81%) of these hemorrhages occurred at home and 44% subsequently died at home. Recognition of this medical complication at the scene is important to prevent the dispatch of the crime scene or homicide unit. In these instances, the common causes of kidney failure included hypertensive cardiovascular disease and diabetes mellitus. The manners of death were certified as therapeutic complication (93%), accident (5%), and suicide (2%). These fatal shunt hemorrhages are rapid and large due to their superficial subcutaneous locations and elevated shunt pressures from the arterial-venous anastamosis. The cause of death statement must include the proximate cause of death, which is usually the disease that resulted in kidney failure, if it is known.
ISSN:1547-769X
1556-2891
DOI:10.1007/s12024-011-9303-0