rsin

ww
om es.c tur

ur w.n

sin
ww
s.c ture om

ur w.n

sin
w
s.co ure t m

.nur ww

sin

rsin

c g-le

tur -lec -lec -lec Complicationsgof Hemodialysis andrtheir management sin sing sing .nur .nu .nur w w w ww ww ww For Nursing
s.c ture om
w lec ings .nur s.c ture om
.nur ww w sin tur -lec g

es.c

rsin

c g-le

om es.c tur
ww sin .nur w

c g-le

es.c

ww
om es.c tur
ww
om es.c ctur

rsin

es.c ctur g-le

om
w ww sin .nur c g-le

sing .nur w

-l

om es.c r ectu
ww
s.c ture om

ur w.n

sin

tur -lec g

es.c

rsin

c g -l e

s.c ture

om
sing .nur w -le

ww
om es.c r

w.n ww

lec ingurs

ww

si .nur w

tur -lec g

es.c

complications of hemodialysis and their management

rsin

tu -lec g

om om es.c es.c t tur They can be broadly dividedur two categories: -lec into -lec sing sing .nur .nur a) Complications during a hemodialysis session. w w ww ww
b) Complications of long-term hemodialysis.

ww

ur w.n

sin

tur -lec g

es.c

m om om s.co es.c This section will deal only witheproblems occurring during a dialysis s.c esession. They can es.c ctur ctur ctur ctur -le -le -le be classified into common problems and uncommon but ing-le complications. sing sing sserious sing r .nur .nur .nur ww that occur during a hemodialysis session. ww ww w w w Complications
om es.c r
Common complications: - Hypotension

rsin

tu -lec g

sing .nur w - Muscle cramps ww

om es.c r
- Nausea and vomiting - Headache

-le

es.c ctur

om
u w.n lec ingrs

om es.c tur
ww ur w.n sin

tur -lec g

es.c

ww
es.c ctur e om

rsin

tu -lec g

sing .nur w ww

-l

ww
es.c ctur -le om

ur w.n

sin

c g-le

s.c ture

om
si .nur ww n

tur -lec g

es.c

w
s.c ture om

om es.c tur -lec

-lec

es.c ctur -le

rsin
ww
om es.c tur

ur w.n

sin
ww
s.c ture om

ur w.n

sin
w
s.co ure t m

.nur ww

sin

rsin

c g-le

- Chest and back pain g-lec sin .nur w - Febrile reactions ww - First-use syndromes

ww
om

ur w.n

sin

c g-le

.nur ww w
om
.nur ww w

sin

tur -lec g

es.c

rsin

c g-le

om es.c - Prutitus tur

sin .nur arrest during dialysis - Cardiopulmonary w ww

Uncommon but serious complications

c g-le

s.c ture

ww

lec ings .nur

s.c ture

sin

tur -lec g

es.c

om om es.c - Disequilibrium syndrome tures.c tur lec -lec ing ingrs urs - Dialyzer reactions w.n ww
- Arrhythmias

ww

sing .nur w

-l

om es.c r ectu
ww
s.c ture om

ur w.n

sin

tur -lec g

es.c

om om es.c - Cardiac tamporade es.c tur tur -lec -lec g sing rsin - Intracranial bleeding .nur w ww
- Seizures

w.n ww

lec ingurs

ww
om

si .nur w

tur -lec g

es.c

rsin

c g-le

om es.c - Hemolysis tur

- Air embolism rsing nu

-l

s.co ure ect

m
sing .nur -l

es.c ctur e

w wwactivation - Dialysis-associated neuropenia & complement

s.c ture
- Hypoxemia. om

w. ww

ww
es.c ctur om

ur w.n

sin

tur -lec g

es.c

rsin

c g-le

lec -le Common clinical problems during a HD session ings sing .nur .nur wwcomplications that occur during a hemodialysis sessions are: ww w w The common
1) Hypotension (20-30% of dialysis), m 2) Muscle cramps (5-20%), g-le

s.c ture

om

.nur ww w

sin

tur -lec g

es.c

rsin

tu -lec g

om es.c r

sin .nur 3) Nauseaww vomiting (5-15%), w and

om es.c r
4) Headache (5%),

es.c ctur

ww

u w.n

lec ingrs

om es.c tur
ww ur w.n sin

tur -lec g

es.c

rsin

tu -lec g

om om es.c es.c tur tur 5) Chest pain (2-5%), and back pain (2-5%), -lec -lec sing sing .nur .nur w w ww ww
es.c ctur -le om
-lec s.c ture om

si .nur ww

tur -lec g

es.c

om es.c tur -lec

es.c ctur -le

rsin
ww
om es.c tur

ur w.n

sin
ww
s.c ture om

ur w.n

sin
w
s.co ure t m

.nur ww

sin

rsin

c g-le

6) Febrile reactions g-lec sin .nur 7) Itching ww w (5%), Fever and chills (<1%),

ww

ur w.n

sin

c g-le

.nur ww w
om
.nur ww w

sin

tur -lec g

es.c

om om es.c 9) Cardiopulmonary arrest. tures.c tur lec -lec ing ingrs urs w.n ww
1) Hypotension

ww

lec ings .nur

s.c ture

sin

tur -lec g

es.c

m om om s.co es.c The cause of hypotension, whichscan be classified into common andeuncommon. e .c es.c ctur ctur ctur ctur -le -le -le -le sing sing sing sing r Common causes r .nu .nur .nur ww ww ww w w w
1.Related to excessive decreases in blood volume

om om om es.c a. Fluctuations in the ultra filtration rate es.c es.c tur tur tur -lec -lec -lec g ng sing rsin b. High ultra filtration rate (to treat a large interdialysis si .nur .nur weight gain) w w ww ww
c.Target dry weight set too low

ww

si .nur w

tur -lec g

es.c

om om es.c d. dialysis solution sodium level s.c low e too tur tur -lec -lec g 2. Related to lack rofing rsin u s vasoconstriction w.n ww a. Acetate-containing dialysis solution
s.c ture

ww

sing .nur

-l

es.c ctur e

om
ur w.n sin

tur -lec g

es.c

ww

rsin

c g-le

b. omFood ingestion (splanchnic vasodilatation) om om es.c es.c tur tur -lec -lec c. Tissue ischemia (adenosine-mediated, aggravated by low hematocrit) sing sing .nur .nur w w ww ww d. Autonomic neuropathy (e.g., diabetic) e. Dialysis solution that is relatively too warm m f. Antihypertensive medications g-le

.nur ww w

sin

tur -lec g

es.c

rsin

tu -lec g

om es.c r

sin .nur 3. Relatedwwcardiac factors w to

es.c ctur

ww

u w.n

lec ingrs

om es.c tur
ww ur w.n sin

tur -lec g

es.c

om om om es.c ventricular hypertrophy, schemicsheart disease, or other conditions res.c e .c tur tur tu -lec -lec rate -lec g b. Failure to increasencardiac si g sing rsin .nur .nur w w ww ww
om es.c tur -lec
es.c ctur -le om
-lec s.c ture om

a. Cardiac output unusually dependant on cardiac filling: Diastolic dysfunction due to left

si .nur ww

tur -lec g

es.c

es.c ctur -le

rsin
ww
om es.c tur

ur w.n

sin
ww
s.c ture om

ur w.n

sin
w
s.co ure t m

.nur ww

sin

rsin

c g-le

(I) Ingestion of beta-blockers lec ingurs w.n (ii) Uremic autonomic neuropathy ww (iii) Aging

ww

ur w.n

sin

c g-le

.nur ww w

sin

tur -lec g

es.c

om om om es.c c. Inability to increase cardiac routput for other reasons: es.c es.c es.c ctur ctu ctur ctur -le -le -le -le sing sing sing sing r ur .nur .nur Poor myocardial contractility due to age, hypertension, atherosclerosis, myocardial ww.n ww ww w w calcification, valve disease, amyloidosis, etc.w

om om om es.c .. es.c es.c es.c ctur ctur ctur ctur -le -le -le -le sing sing sing sing r uncommonw.nur causes .nur .nur w ww ww w w w 1.Pericardial tamponade

om om es.c 2.Myocardial infarction tures.c tur lec -lec ing ingrs 3.Occult hemorrhage urs w.n ww
4.Septicemia

w.n ww

lec ingurs

s.c ture

om
si .nur w n

tur -lec g

es.c

ww
om

rsin

c g-le

s.c ture

om 5.Arrhythmia
6.Dialyzer reaction ing rs 7.Hemolysis

-l

s.co ure ect

m
w sing .nur -l

es.c ctur e

.nu ww w

ww
s.c ture om

ww
es.c ctur om

ur w.n

sin

tur -lec g

es.c

rsin

c g-le

s.c ture

8.Air om embolism

lec -le Detection of Hypotension: ings sing .nur .nur ww will complain of feeling dizzy,www w Most patients light-headed, or nauseated when

.nur ww w

sin

tur -lec g

es.c

rsin

hypotension occurs. Some experience muscle cramps. Other may experience no symptoms whatsoever until the bloodm pressure falls to extremely low (and dangerous) .com Thus, blood pressure must .comonitored on a regular basis ines.com s levels. s be all patients ure throughout the hemodialysisture ur lect lec session. lect ggg-

sin .nur w Management of hypotension ww

a) Fluid administration:

ww

si .nur w

ww

ur w.n

sin

tur -lec g

es.c

rs

lec ing-

tu

om es.c r

om .com es.c episode is straightforward.turespatient should be es.c Management of the acuteectur hypotensive c The ctur -l -le -le placed in the trendelenburg position (if respiratory statusiallows this). A bolus of 0.9% sing s ng sing .nur .nur .nur ww ww ww w w w
es.c ctur -le om
-lec s.c ture om

om es.c tur -lec

es.c ctur -le

rsin
ww
om es.c tur

ur w.n

sin
ww
s.c ture om

ur w.n

sin
w
s.co ure t m

.nur ww

sin

rsin

c g-le

an alternative to 0.9% saline, hypertonic saline, glucose, mannitol, or albumin solutions can be used to treat the hypotensive episode. Unless cramps are also present, use of om om om hypertonic solutions appears to offer no benefit over 0.9% saline. Nasal oxygen es.c administration may also be of res.c by virtue of helping to improve s.cmaintain e or tur tu benefit tur -lec -lec -lec g g g myocardial performance. rsin rsin rsin

tur saline (100 ml or more, -as c le necessary) should be rapidly administered through the venous -lec -lec si g sing sing blood line. The ultran .nur filtration rate should be reducedur as near zero as possible. Ultraw.nur .n to w w filtration can be resumed (at a slower rate, initially) once vital signs have stabilized.w ww ww w As
tur -lec g

es.c

es.c

w b) Slowing the blood flow rate:

u w.n

ww

u w.n

.nur ww w

sin

In dialysis hypotension was to slow the blood flow omthe past, part of initial therapy forom om es.c rate, a practice developed atta res.c es.c solution es.c u time when ctur cfour potential plate dialyzers and -acetate dialysis to treat ctur flow rate ctur le l blood -le -le were being used. There -are reasons to lower thee sing sing sing sing r hypotension: .nur .nur .nur ww ww ww w w w I) when plate dialyzers are used, reduction of the blood flow rate reduces pressure in the blood compartment of the dialyzer. The plates come closer together, reducing the total om om .com es volume of the extracorporeal circuit. es.c es.c r r r

rsin

tu -lec g

tu tur -lec -lec g g ii) When acetateursin solution is used, reduction of rsin flow rate reduces transfer of ursin dialysis blood .n .nu .n w w acetate to wwpatient. w the ww ww

tu -lec g

es.c

om to limit the amount of ultra .com om easier filtration. es.c es es.c es.c ctur ctur ctur ctur le -le -le -le iv) At very rapid blood sing sing flow rates and at a low cardiac routput, there may be a "steal" sing sing r .nur .nur effect by the extracorporeal circuit, with diversion .nu ww ww of blood from systemic tissue beds. ww w w w
Prevention of hypotension:

iii) When an ultra filtration controller is not used, slowing the blood flow rate makes it

om om om es.c A useful strategy to help prevents.c e hypotension during dialysis is: tures.c tur tur lec -lec -lec i ng ing ingrs urs 1-Use a dialysis urs w.n machine with an ultra filtration controller whenever possible. w.n ww ww
2-Counsel patient to limit weight gain to < 1 kg/day.

.nur ww w

sin

tur -lec g

es.c

m om om to s.co es.c 3-Do not ultra filter a patienturebelow his or her dry weight. es.c tur t tur -lec -lec -lec g g g 4-Keep dialysis ursin sodium level at or above theursin level. solution plasma rsin .n .n w w ww ww
5-Give daily dose of antihypertensive medications after, not before, dialysis.

ww

ur w.n

sin

tur -lec g

es.c

om bicarbonate-containing dialysism o solution when high blood flow s.coor high6-Use rate m es.c efficiency dialyzers are used.ures.c e es.c ctur ct ctur ctur -le -le -le -le sing sing sing sing r .nur .nur .nur ww ww ww w w w
om es.c tur -lec
es.c ctur -le om
-lec s.c ture om

es.c ctur -le

rsin
ww
om es.c tur

ur w.n

sin
ww
s.c ture om

ur w.n

sin
w
s.co ure t m

.nur ww

sin

rsin

c g-le

tur 7-In selected patients, g-lec try lowering the dialysis solution temperature to 34-36C. -lec -lec sin sing sing .nur .nur .nur w w w 8-Ensure that hematocrit is > 25-30% pre-dialysis. ww ww ww
9-Do not give food or glucose orally during dialysis to hypotensive-prone patients. Muscle cramps

es.c

rsin

c g-le

om es.c tur

sin sin .nurof muscle cramps during dialysis is unknown. The three most importantur .n The pathogenesis w w w ww ww ww predisposing factors are hypotension, the patient being below dry weight, and/or use of
sodium-poor dialysis solution.

c g-le

s.c ture

om

lec ings .nur

s.c ture

om

tur -lec g

es.c

om om om es.c Management: es.c es.c es.c ctur ctur ctur ctur le -le -le -le ingsing sand muscle cramps occur concomitantly, the hypotension may sing sing r When hypotension .nur .nur .nur ww ww cramps may persist. Muscle-bed ww w w respondw treatment with 0.9% saline, but the muscle to
blood vessels can be dilated by hypertonic solutions. Perhaps for this reasons, administration of hypertonic saline orm glucose is very effective in the acutem management .commuscle cramps. .co .co res of res res Prevention of nursin cramps:

rsin

tu -lec g

tu -lec g

Prevention of hypotensive episodes will eliminate the majority of episodes of cramping. Increasing the dialysis solution sodium level to 145 mmol/liter or higher may also be of m om benefit. Strategies of decreasing s. om dialysis sometimes can be usefuloto treat patients sodium es.c with refectory intradialytic cramps.cStart out with a sodium leveltofres.c and program e es.c ctur ctur c u 150-155 ctur le le -le -le in a linear fashion,sing- to 135-140 mmol/liter by the iend-of treatment. Carnitine decrees sing s ng sing r ur .nur .nur supplementation of dialysis patients might result w.n ww w in fewer muscle cramps during dialysis. ww w w w Other strategies are to administer orally quinine sulfate 260 mg, or oxazepam 5-10 mg, 2 hours prior to dialysis. A program of stretching exercises targeted at the affected muscle groups may also be useful. om om om

ww

w.

w.n ww

tu -lec ng ursi

ww

si .nur w

tur -lec g

es.c

rsin

tur -lec g

es.c

ctur Nausea and vomiting -le sing .nur w w Etiology: w

es.c

.nur ww w

sin

es.c ctur g-le

.nur ww w

sin

tur -lec g

es.c

Nausea or vomiting occurs in up to 10% of routine dialysis treatments. The etiology is om om .com es multifactorial. Most episodesuin stable patients are probably relatedrtoshypotension. es.c e .c es.c r ctur ct be early manifestation of the so-called disequilibrium ctu ctur Nausea or vomiting can-le also -le -le -le sing sing sing sing syndrome. r .nur .nur .nur ww ww ww w w w Management:

om first step is to treat any associated hypotension. If nausea persists, anom om The s.c antiemtic can es.c be administered. es.c es.c ur ur ure ct ct ct ctur -le -le -le -le sing sing sing sing r .nur .nur .nur ww ww ww w w w
om es.c tur -lec
es.c ctur -le om
-lec s.c ture om

es.c ctur -le

rsin
ww
om es.c tur

ur w.n

sin
ww
s.c ture om

ur w.n

sin
w
s.co ure t m

.nur ww

sin

rsin

c g-le

Prevention:

.nur w Avoidance of hypotension during dialysis is ofw prime importance. In some patients, ww w w w
om es.c Headache tur
reduction of the blood flow rate by 30% during the initial hour of dialysis may be of benefit. A change to bicarbonate dialysis can be helpful.

ur w.n

sin

c g-le

ur w.n

sin

c g-le

sin

tur -lec g

es.c

rsin

c g-le

sin .nur Etiology: ww w

c g-le

s.c ture

om

ww

lec ings .nur

s.c ture

om

.nur ww w

sin

tur -lec g

es.c

Headache is a common symptom during dialysis, the cause of which is largely unknown. It may of the disequilibrium syndrome or may bem om be a subtle manifestation s.com o related to use es.c of acetate-containing dialysis solution. In patients who are coffeetures.c headache may e es.c ctur ctur c drinkers, ctur le -le -le -le be a manifestation of caffeine withdrawal as the blood caffeine concentration is acutely ingsing sdialysis treatment. sing sing r ur ur ur reduced during the w.n w.n w.n

ww

ww

ww

Management:

om om om es.c Acetaminophen can be givenuduring dialysis. es.c es.c tur t r tur -lec -lec -lec g g sing rsin Prevention: nursin . .nur w w ww ww
tur -lec g e
tur -lec Chest and back pain g sin .nur w ww e
tur -lec g e

As for nausea and vomiting, a reduction in the blood flow rate during the early part of the dialysis treatment can be tried. A change to bicarbonate-containing dialysis solution is m m om s.c sometimes beneficial. s.co s.co

ww

si .nur w

tur -lec g

es.c

rsin

Chest pain (often associated with back pain) w occurs in 1-4% of dialysis treatment.w The cause is unknown but may be related to complement activation. There is no specific management or prevention strategy other than switching to a synthetic orom substituted om om es.c cellulose membrane. The occurrence of angina during dialysis is tcommon, and this as es.c es.c es.c tur ctur cpotential cause of chest pain (e.g.,lec ur ctur -le -le - hemolysis) must be -le well as the numerous other sing sing sing sing r ur ur considered in .nur w the differential diagnosis. w.n w.n

sin .nur w

ur w.n

sin

tur -lec g

es.c

ww

ww

ww

Immediate treatment:

om om om es.c The treatment of symptoms tis rsupportive, with nasal oxygen andtantihistamines. Usually es.c es.c es.c ctur c u abate within an hour, and theedialysis treatment can be c ur ctur the symptoms are not severe and -le -le -l -le sing sing sing sing completed. r .nur .nur .nur ww ww ww w w w
Prevention:

m om syndrome may be prevented byousing a more biocompatible membrane or enrolling om This es.c the patient in a reuse program res.c preprocessed new dialyzers. tures.c es.c ctur ctu using c ctur -le -le -le -le sing sing sing sing r .nur .nur .nur ww ww ww w w w
om es.c tur -lec
es.c ctur -le om
-lec s.c ture om

es.c ctur -le

rsin
ww
om es.c tur

ur w.n

sin
ww
s.c ture om

ur w.n

sin
w
s.co ure t m

.nur ww

sin

rsin

c g-le

Febrile reactions

rsin

tur -lec g

blood cultures. The suspicion of infection should be particularly high in patients with right atrial dialysis catheters. Fistula or graft infections may be subtle, and empirical m m om s.c treatment with antibiotics may become necessary in many cases. s.co s.co Pathophysiology:sin r

.nur w w w and In general, febrile episodes should be aggressively evaluated with appropriate wound w w w w
tur -lec g e
tur -lec sing .nur e

ur w.n

sin

c g-le

ur w.n

sin

c g-le

sin

tur -lec g

es.c

rsin

c g-le

w w Febrile reactions during the course of treatment may be related to exposure to endotoxins originating from the dialyzer or dialysate. Such events may be associated with chills, nausea, and more rarely, hypotension.m after om o Febrile reactions occurring shortlyom treatment es.c are characteristic of systemicuinfections. es.c es.c tur t r tur
Immediate w.nur treatment:

u w.n

ww

.nur ww w

sin

tur -lec g

es.c

sin

c g-le

ww

ww

si .nur w

c g-le

ww

ur w.n

sin

tur -lec g

es.c

rsin

tu -lec g

Treatment of endotoxin related fever is generally supportive with antipyretics. In most cases the dialysis treatment can be completed. Infection-related fever is treated with om om .com end es antibiotics administrated at the es.cof the treatment. es.c r r r Prevention: nursin w.

tu -lec g

Prevention of endotoxin-related fevers requires effective cleaning and disinfection of dialysis equipment with particular attention to the water-treatment system. In general, the om of such endotoxins will be .from contaminated water used for dialyzer reprocessing om om source es.c or for preparing dialysate. However, endotoxin exposure may occur es.c new dialyzers es c es.c ctur ctur ctur from ctur -le -le -le -le as well. Clusters of pyrogenic reactions should promptra ithorough review of the sing sing s ng sing r r . r .nu procedures for nu disinfection and monitoring. Water used in the dialysis unit should.nu ww water ww ww w w w have a bacterial content of less than 200 CFU/ml and be free of endotoxin as judged by the limulus amebocyte lysate test. Bicarbonate dialysate should be prepared fresh daily, and om if it is prepared in quantity, thecholding tank should be relatively smallm constant om o with s.c es.c recirculation. es. es.c tur tur tur ture

ww

w.n ww

tu -lec ng ursi

ww

si .nur w

tur -lec g

es.c

grsin

lec

ngursi First-use syndromes w.n ww

lec

w.n ww

lec ingurs

w.n ww

ngursi

lec

rsin

The term first-use syndrome refers to two clinical conditions: an immediate hypersensitivity reaction and a symptom complex of nonspecific chest andm back pain. .com immediate hypersensitivity reaction is particularly noted with cuprophane .com .co The s s s ure membranes. ure ure lect lect lect -

sin .nur w Pathophysiology: ww

ww

si .nur w

ng

ww

ur w.n

sin

tur -lec g

es.c

om o sterilization of new dialyzers. Recently, similar om reaction to ethylene oxide used in .the m es.c reactions have been observed in patients taking angiotensin-converting.enzyme (ACE) es c es c es.c ctur ctur ctur ctur le -le -le -le inhibitors. The symptoms include anxiety, dyspnea, uricaria,-and pruitus that may sing sing sing sing r .nur .nur .nur ww ww ww w w w
om es.c tur -lec
es.c ctur -le om
-lec s.c ture om

In many cases an immediate hypersensitivity response may related to IgE-mediated

es.c ctur -le

rsin
ww
om es.c tur

ur w.n

sin
ww
s.c ture om

ur w.n

sin
w
s.co ure t m

.nur ww

sin

rsin

c g-le

tur manifest in a wide spectrum of severities, ranging from mild-discomfort to true lec -lec -lec g sing sing anaphylaxis. nursin . .nur .nur w w w ww ww ww
Immediate treatment:

es.c

om om om Immediate treatment involves stopping dialysis, clamping the dialysis lines, and es.c discarding the blood and dialyzer..Symptoms are treated supportivelys.c oxygen, es c e with es.c ctur ctur ctur ctur -le -le -le -le antihistamines, bronchodilators, epinephrine, and steroidsng required. Dialysis may be sing sing si as sing r nur .nur .nur resumed with .a new dialyzer, preferably of different membrane composition. ww ww ww w w w
Prevention:

om om om es.c Prevention involves adequate dialyzer rinsing before commencing dialysis and, rarely, es.c es.c es.c ctur ctur ctur ctur -le -le -le -le the use of dialyzers isterilized by other means. sing s ng sing sing r .nur .nur .nur ww ww ww w w w Pruritus
Pathophysiology: .com res

rsin

tu -lec g

tur The pathophysiologic g-le for uremic pruitus remains to be -lec basis elucidated. Many dialysis -lec g sin sing patients have bothersome itching, some of whom experience an exacerbation during or nursin .nur Among the many reported etiologic factors is dryness of the skin, w. .nur w soon afterww w dialysis. ww ww
secondary hyperparathyroidism, abnormal skin levels of calcium, magnesium, and phosphorus, abnormalities in plasma histamine concentration, or mast cell proliferation.

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om om om es.c Immediate treatment: es.c es.c es.c ctur ctur ctur ctur -le -le -le -le sing sing sing sing r ur ur .nur Treatmentww.n has remained largely empirical and includes general measures such as skinw.n ww w w w w lotions and tepid baths as well as antihistamines, oral charcoal, ultraviolet phototherapy
or cholestyramine.

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of dialysis.

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om om om es.c Cardiopulmonary arrest during.c es dialysis es.c es.c ctur ctur ctur ctur -le -le -le -le sing sing s ng sing Catastrophic cardiorespiratory collapse may occur rarelyiduring a dialysis treatment. r .nur .nur .nur Decisionsww be made quickly as to whether wwcollapse is due to an intrinsic disease must the ww w w w
alone or whether technical errors have occurred. Major technical problems include air embolism, unsafe dialysate composition, over-heated dialysate or line disconnection. Air omthe dialysate lines, grossly translucent hemolyzed blood, and hemorrhage due to a line om om in es.c disconnection may be immediatelycapparent. es. es.c r r r ectu ectu ectu

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present as a cardiorespiratory arrest during this initial period. The dialyzer should be checked as to its use number and composition. Formaldehyde infusion is associated with om om complaints of burning at the access site and, unless the patient had beencom to s. unable es.c communicate, should be apparent..c es ur ur ure lect lect lect

tur If the arrest occurs immediately upon initiation of treatment -lecthe cause is unknown, and -lec -lec s ng sing sing blood should not beireturned to the patient. An anaphylactic reaction to the dialyzer .nur .nur .nur w membrane or infusion of formaldehyde fromwwinadequately rinsed reused dialyzerww an w ww w could
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ngngn ursi ursi to suspect problems with .nursi .n intra-dialytically and there is no.n If the event w occurs w reason w ww ww ww dialysate composition, blood should be returned to the patient promptly. A sample of the

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dialysate should be sent for immediate electrolyte analysis along with the first patient blood com samples. The dialyzer and blood lines should be saved for later analysis. com com

es. es. es.c ctur ctur the patient from the ctur -le -le The above assessmentg-le is performed simultaneously with iremoval of sin s ngfor cardiopulmonary sing dialysis chair .nurplacement of the floor, where procedures and .nur .nur wware immediately implemental. Access lines should remain in place towww ww w w resuscitation
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provide a route for administration of saline and medications. After any cardiopulmonary arrest, the dialysis machine should be m replaced until all its safety features have been om .com thoroughly evaluated for possible .co malfunction. es es es.c r r r

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