8/7/2019 HD Complications
1/16
8/7/2019 HD Complications
2/16
8/7/2019 HD Complications
3/16
Hemolysis
Power Failure
8/7/2019 HD Complications
4/16
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
8/7/2019 HD Complications
5/16
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
8/7/2019 HD Complications
6/16
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
8/7/2019 HD Complications
7/16
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
8/7/2019 HD Complications
8/16
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
8/7/2019 HD Complications
9/16
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
8/7/2019 HD Complications
10/16
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
8/7/2019 HD Complications
11/16
8/7/2019 HD Complications
12/16
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
8/7/2019 HD Complications
13/16
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
8/7/2019 HD Complications
14/16
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
8/7/2019 HD Complications
15/16
8/7/2019 HD Complications
16/16