HD Complications

8/7/2019 HD Complications

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Hemolysis

Power Failure


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CausesAir detector is broken and not armedA leak or loose connection in the extracorporeal circuit before the

blood pumpEmpty IV bags in the extracorporeal circuit before the blood pump

Signs and symptomsDepends on the patients body position when the air is infused

Chest painTrouble breathingCoughingBlue lips, fingers, toes (cyanosis)

How to prevent itArm the air detector throughout a treatment

Tighten all connections in the extracorporeal circuitCheck the normal saline level in the IV bagReturn the patients blood with saline, with no air in the bloodlines

CausesEthylene oxide (a new dialyzer germicide) allergyReaction to germicide left in the bloodlinesDrug allergy (e.g. to iron dextran, heparin)

Signs and symptomsTrouble breathing (throat may close up)HypotensionItchingHives

Feeling anxiousBurning feelingUnusual feelingUnusual smellCardiac arrest

How to prevent itRinse dialyzers and bloodlines well during equipment preparationAvoid drugs the patient has a known allergy to

- air bubbles block a

blood vessel

- severe allergic reaction


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CausesChanges in blood pH or electrolyte levels, especially potassiumHypotensionHeart disease

Signs and symptomsIrregular pulse (skipped or extra beats)

Slow or fast pulsePatient has palpitations (strong heart beats)

How to prevent itUse the right dialysate concentrateManually check the patients pulse during treatmentMonitor blood pressure

chest pain due to lowoxygen levels in the heart

irregular heartbeats

CausesCoronary artery disease (blocked heart arteries)Anemia (shortage of red blood cells)Hypotension

Anxiety

Signs and symptomsPain or tightness in chestPatient may be pale, cold, sweating and have troublebreathing

How to prevent itMonitor blood pressure closely to avoid hypotension

Calculate the fluid goal correctly


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CausesRemoving too much fluidChanges in blood chemistry, especially sodiumLow potassium levelsHypotension

Signs and symptomsPainful muscle cramps, often in the hands and feet

How to prevent itGet an accurate weight before a treatmentCorrectly calculate the fluid goalUse the prescribed dialysate concentrateEncourage patients to follow their slat and fluid limits

CausesExtreme hypotensionElectrolyte imbalance, especially high potassiumArrhythmiasHeart attackAir embolismSevere blood loss

Signs and symptomsNo pulseNo breathingLoss of consciousness

How to prevent itCheck vital signs during treatmentTell the nurse right away about major vital sign changesand/or the patient complains of chest pain and sweating

- the heart stops


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CausesInfectionContaminated dialyzer or bloodlines(endotoxin exposure)Too-cold dialysate

Signs and symptoms

Fever during dialysis feeling coldFeeling cold without a fever (cold dialysate)Redness, swelling, tenderness, warmth, ordrainage from access or other sites (e.g. feet,skin wounds)

How to prevent itUse aseptic technique to set-up equipmentUse aseptic technique to inserting needlesCheck vital signsTell the nurse right away about major vitalsign changesCheck dialysate temperature before treatmentUse the right process to disinfect the dialysismachine and the water componentsTest the water and equipment for bacteria orpyrogens/endotoxins

CausesIf BUN is removed much faster than the

blood than from the brain, disequilibrium iscreated and fluid moves into the brain cellsThis is seen more often in patients whohave acute kidney disease or a BUN level of> 150 mg/dL

Signs and symptomsHeadacheNausea

HypertensionRestlessnessConfusionBlurred visionSeizures

How to prevent itMonitor the patient during treatmentTell the nurse right away about major vital

sign changesIn patients with high BUN (>150 mg/ml) asmaller dialyzer and/or slower blooddialysate flows are preferred. Short, slowdialyses may be prescribed daily for a fewtreatments

- Brain swelling


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CausesError in heparin dosingBroken heparin pump

Signs and symptomsUnusual bleeding around needlesLonger than normal bleeding from needle sites after treatment

How to prevent itDraw up heparin doses correctlyUse the right dialyzerUse the right type of heparinMonitor the heparin pump during treatment

CausesReaction to ethylene oxide (use to sterilize new dialyzers)Use of polyacrilonitrile (PAN) membranes in patients who take

ACE inhibitors (a class of blood pressure pills)

Signs and symptomsSymptoms usually occur in the first 15-30 minutes of treatment:Itching chest and/or back painShortness of breathHypotensionNauseaGeneral discomfort

How to prevent itRinse the dialyzer well before treatment, per center procedureUse the right dialyzer


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CausesRemoving too much fluidTaking BP pills before dialysisHeart disease

Signs and symptoms

Low BP readingDizzinessTachycardia (rapid pulse)Loss of consciousness

How to prevent itGet an accurate weight before a treatmentCalculate the fluid goal correctlyAsk patients if theyve taken their BP pills

CausesFluid overloadPatient missing their blood pressurepillsAnxietyDialysis disequilibrium syndrome

Signs and symptomsMay have no symptomsHeadacheNervousness

How to prevent itCalculate the fluid goal correctlyAsk patients if theyve taken their BPpillsEncourage patients to follow their fluidlimits


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CausesSevere hypotensionElectrolyte imbalanceDialysis disequilibrium syndrome*Seizure disorder (epilepsy)

Signs and symptomsChange in the level of consciousnessJerking movements of the arms and legs

How to prevent itMonitor BPCheck that patients with epilepsy aretaking their medications

CausesUremia (high BUN)High blood phosphorus levelsCalcium phosphate crystalsunder the skinSecondary hyperparathyroidism

Signs and symptomsSevere itching on and off dialysisRed skinCrusting on the sin

How to prevent itKeep skin dry and clean

Deliver dialysis treatmentcorrectlyAsk patients if they are takingtheir phosphate binders

- itching


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CausesWrong and/or inadequate anticoagulationLow blood flow rateAir in the extracorporeal circuit

Signs and symptomsBlood turns very darkClots in the extracorporeal circuit (see duringrinseback)

If clotting in dialyzer, may see a decrease invenous drip chamber pressureIf clotting in venous chamber, may see anincrease in venous drip chamber pressure

How to prevent itGive heparin as prescribedMaintain prescribed blood flow ratesPrime the extracorporeal circuit correctly before

treatment starts

CausesUnderfilling of drip chambersEmpty saline bagLoose connections in the extracorporeal circuit

Dialysis needle taken out while blood pump is onAir left in extracorporeal circuit after priming

Signs and symptomsAir bubbles or foaming in the bloodlinesAir in the blood alarmMay see collapse of arterial bloodlines

How to prevent it

Keep correct drip chamber levelsBe sure the saline bag is not empty and line staysclampedTighten all connectionsTape needles securelyPrime the extracorporeal circuit correctly beforetreatment startsCheck for cracks or holes in needle lineconnections


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severe loss of blood

CausesKinked bloodlinesInadequate water treatment that allows

chloramines, copper, zinc, or nitratesinto the dialyzer

Signs and symptomsNauseaHeadacheStomach and back painHypertension or hypotensionCardiac arrest

Bright red colored blood

How to prevent itCheck dialysate conductivity andtemperature before treatmentTest dialysate for chloramines anddisinfectantsMonitor bloodlines for kinksCheck that blood pump is calibrated for

the bloodline header being used

CausesBloodlines come apartTaking out dialysis needles with theblood pump onCrack in dialyzer casing or improperlyfitted header capAccess rupture

Signs and symptomsBlood on patient chair, clothes, and/orfloorHypotensionSeizuresCardiac arrest

How to prevent itTighten all extracorporeal connectionsTape needles securelyKeep all accesses in view at all times(no blankets over access limbs)Monitor the extracorporeal circuit perprocedure

bursting of red blood cells


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CausesMachine failureMachine unpluggedPower outrage

Signs and symptoms

Machine stops during treatmentNo lights on machine

How to prevent itCheck that the machine is completely plugged in before treatmentBe sure the machine has been maintained per center procedure


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