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Previous patient safety initiatives promote prevention of treatment complications; yet, they have placed little specific focus on avoidable session instability. A patient-centered definition of session instability grounded in patient experiences, and an understanding of patient perceptions of causes and solutions to instability, may enable such efforts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Twenty-five participants participated in three focus groups and\/or a survey. They were purposively sampled for variation in region of residence, and sensitivity to patient well-being. Focus group recordings were analyzed using descriptive coding, in vivo coding, and thematic analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patients define unstable sessions (\u201cbad runs\u201d) as those in which they experience severe discomfort or unanticipated events that interfere with their ability to receive therapy. Bad runs were characterized primarily by cramping, low blood pressure (\u201ccrashing\u201d), cannulation-related difficulties (\u201cbad sticks\u201d), and clotting of the dialysis circuit or vascular access. Patients believed that cramping and crashing could be explained by both patient and clinician behavior: patient fluid consumption and providers\u2019 fluid removal goals. Patients felt that the responsibility for cannulation-related problems lay with dialysis staff, and they asked for different staff or self-cannulated as solutions. Clotting was viewed as an idiosyncratic issue with one\u2019s body, and perceived solutions were clinician-driven. Patients expressed concern about \u201cbad runs\u201d on their ability to achieve fluid balance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Findings point to novel priorities for efforts to enhance hemodialysis session stability, and areas in which patients can be supported to become involved in such efforts.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12882-020-01726-8","type":"journal-article","created":{"date-parts":[[2020,2,27]],"date-time":"2020-02-27T08:02:54Z","timestamp":1582790574000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Cramping, crashing, cannulating, and clotting: a qualitative study of patients\u2019 definitions of a \u201cbad run\u201d on hemodialysis"],"prefix":"10.1186","volume":"21","author":[{"given":"Pei-Yi","family":"Kuo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajiv","family":"Saran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marissa","family":"Argentina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Heung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Bragg-Gresham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Krein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda W.","family":"Gillespie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1200-9515","authenticated-orcid":false,"given":"Tiffany C.","family":"Veinot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,2,27]]},"reference":[{"issue":"1","key":"1726_CR1","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1046\/j.1523-1755.2003.00072.x","volume":"64","author":"DL Mapes","year":"2003","unstructured":"Mapes DL, Lopes AA, Satayathum S, Mccullough KP, Goodkin DA, Locatelli F, et al. 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