CLINICAL COMPLICATIONS OF HEMODYALISIS

AIR BUBBLES ARE CARRIED BY THE BLOOD STREAM INTO A VESSEL SMALL ENOUGH TO BE BLOCKED BY THE BUBBLES.

• DEFECTIVE AIR DETECTOR, AN EMPTY SALINE BAG, CARELESS IV ADMINISTRATION,LOOSE BLOODLINE CONNECTIONS OR A LEAK BEFORE THE BLOOD PUMP.
• SEPARATION OF AN ARTERIAL BLOODLINE, VERY COLD DIALYSATE, AN UNCAPPED  AND UNCLAMPED CATHETER.

• AIR ON FOAM IN THE VENOUS LINE
• NO CAPS OR CLAMPS ON CATHETER

• CHANGES IN VISION
• CONFUSION
• SLIGHT PARALYSIS OF ONE SIDE OF THE BODY
• SEIZURE, STROKE, COMA, OR DEATH.

SECURE ALL BLOOD CIRCUIT CONCOCTIONS,ARM THE AIR DETECTOR A ALL TIME,LOOK THE VENOUS BLOODLINE FROM AIR DETECTOR ,VERIFY CATHETERS ARE CLAMPED AND REMOVED,REMOVE EMPTY IV BAGS, DOUBLE CLAMP THE SALINE LINE, CHECK THE VENOUS BLOOD LINE, BLOOD PUMP SPEED TO A RATE ACCESS CAN DELIVER.

SEVERE ALLERGIC REACTION

• SENSITIVITY TO ETHYLENE OXIDE (ETO)
• TAKING AN ACE 
• REACTION TO GERMICIDE 
• MEDICATION 
• REACTION TO A DIALYZER MEMBRANE.

• REACTION IN  THE 5-30 MINUTES OF HD
• REACTION 5-10 MINUTES AFTER MEDICINE

TROUBLE BREATHING, CHEST TIGHTNESS, TACHYCARDIA, CARDIAC ARREST, HYPOTENSION,FEELING ANXIOUS, OR RESTLESS, FLUSSING, HIVES AND ITCHING, TEARING UP, SWELLING,AROUND THE EYES, RUNNY NOSE, ABDOMINAL CRAMPING, NUMBNESS AND TINGLING AROUND THE MOUTH, LOW BACK PAIN, BURNING AND PAIN AT THE VENOUS.

• AVOID DRUGS THE PATIENT HAS ALLERGY
• RINSE FIRST USE DIALYZER
• RINSE DIALYZER AND BLOODLINES DURING THE TREATMENT

CHEST PAIN DUE TO LOW OXYGEN LEVELS IN THE HEART

• CORONARY ARTERY DISEASE 
• HYPOTENSION 
• ANXIETY 
• ANEMIA 
• CARDIAC STUNNING

• PAIN OR TIGHTNESS IN CHEST, ARM PR JAW 
• SWEATING, COLD, TROUBLE TO BREATHING 
• HOPYTENSIVE

• BLOOD LOSE 
• AVOID HYPOTENSION
• TREAT ANEMIA
• SET UF GOAL OF 13ML/KG/HR

IRREGULAR HEARTBEAT

• UNDERLYING HEART DISEASE
• CHANGES IN PH
• HYPOTENSION 
• HEART DISEASE
• CARDIAC STUNNING FROM AGGRESSIVE UF

• IRREGULAR PULSE
• SLOW OR RAPID HEART PULSE
• PALPITATIONS
• ANXIETY

• VERIFY DIALYSATE POTASSIUM
• MONITOR RATE AND RHYTHM 
• MONITOR BLOOD PRESSURE
• MONITOR THE UFR TO PREVENT HYPOTENSION.

EXTREMELY HYPERTONIC SOLUTION

• RISE OR FALL PULSE
• CARDIAC ARREST 
• CHEST PAIN 
• CYANOSIS 
• HEMOLYSIS
• DROP BP
• TROUBLE BRETHDING AND VOMITING

THE HEART STOP BEATING

• HYPOTENSIA, HIGH POTASSIUM, ARRHYTHMIAS, HEART ATTACK, AIR EMBOLISM,HEMOLYSIS, EXSANGUINATION .
• NO CAROTID PULSE
• NO BREATHING 
• LOSS OF CONSCIOUSNESS

• PREVENT CARDIAC ARREST AND RAPID POTASSIUM SHIFTS  
• CHECK VITAL SIGNS DURING THE TREATMENT MAJOR CHANGES TELL THE NURSE 
• UF GOAL NOT TO HIGH
• CHECK THE VASCULAR ACCESS AND BLOODLINES  CONNECTIONS

DROOP IN BLOOD FLOW TO THE HEART MUSCLE.

• AGGRESSIVE UFR, HYPOTENSION, HYPOVOLEMIA.
• SYMPTOMATIC BP DROOP
• MUSCLE CRAMPS
• CHEST PAIN

LOWER DIALYSATE TEMPERATURE, AVOID UFR ABOVE 13ML/KG/HR, USE BLOOD VOLUME,MONITOR PATIENT, TEACH PATIENT WATER GAINS, MORE HD FOR  HYPOVOLEMIA,  UFR TIME REDUCE, REASSESS TARGET WEIGHT.

• CARDIAC ARREST,ANAPHYLATICK SHOCK,BLOOD LESS,STROKE
• UNRESPONSIVE NOT BREATHING NO PULSE .
• NOT BE PREVENTABLE

s defined as a clinical syndrome of neurologic deterioration that is seen in patients who undergo hemodialysis. It is more likely to occur in patients during or immediately after their first treatment, but can occur in any patient who receives hemodialysis

• NEW PATIENT WITH VERY HIGH BUN LEVELS.
• HIGH BLOOD PRESSURE , CHANCE IN THE LEVEL OF CONSCIOUSNESS, IRREGULAR PULSE ,COMA O DEATH.
• MONITOR PATIENT DURING THE TREATMENT,TELL THE NURSE ABOUT VITAL SIGNS CHANGES , IF BUN IS 150MG/DL USE SMALLER DIALYZER, SLOWER BLOOD AN DIALYSATE FLOW,SHORT AND SLOW TREATMENTS DAILY.

• FAIULE TO CONNECT THE VENOUS AND SEPARATION OF THE  BLOODLINE, NEEDLE DISGORGEMENT, FISTULA OR GRAFT AND DIALYZER RUPTURE.
• A LOT OF BLOOD, PINK OR RED DIALYZATE IN THE DIALYZER ,
•  LOW PRE-PUM ARTERIAL PRESSURE.
• BP DROPS, RAPID HEART OF BREATH, SHOCK, SEIZURES,CARDIAC ARREST.

CHECK DIALYSIS ACCESS AND LINES CONNECTED,TAPE THE NEEDLES, SECURE LOOPED BLOODLINES,TEST ALL MONITORS AND BLOOD LEAKS DETECTORS, LOOK AROUND FOR BLOOD.

• INFECTION, TOO HOT OR TO COLD DIALYSATE,DIALYZER CONTAMINATED, REACTION TO DIALYZATE WATER,BREAK IN STERILE TECHNIQUE.
• LOCAL INFECTION REDNESS, SWELLING, WARMTH,O DRAINAGE FROM THE ACCESS. PYROGENIC REACTION:FEVER OR CHILLS.

WASH YOU HANDS,VITAL SIGNS, ASEPTIC TECHNIQUES, CHECK FOR INFECTION, CHECK DIALYSATE TEMPERATURE, DISINFECT DIALYSIS MACHINE, RECIRCULATION

• REACTION TO ETHYLENE OXIDE,ALLERGY TO THE DIALYZER MEMBRANE.
• REACTION IN THE FIRST 5-10 MINUTES. 
• ITCHING, CHEST AND BACK PAIN,SHORTNESS AT BREATH,HYPOTENSION,NAUSEA,DISCONFOT.
• RINSE NEW DIALYZER , DO NOT REMOVE THE MEMBRANE PROTEIN COATING.

• HEPERTENSION,FLUID SHIFT,DDS,TENSION,DROP BLOOD SUGAR,CAFFEINE OR ALCOHOL WITHDRAWAL.
• COMPLAIN O PATIENT HOLD THE HEAD,SENSITIVITY THE LIGHT OR SOUNDS.
• CORRECT TARGET WEIGHT,SET THE UFG CORRECTLY, ENCOURAGE THE PATIENT TO FOLLOW THE LIMITS OF LIQUIDS AND SODIUM,FOR DDS USE SLOWER AND/OR MORE FREQUENT, CHECK BLOOD SUGAR.

• ERROR IN THE FIRST HEPARIN DOSE,AND INFUSION PUMP SETTINGS,TOO MUCH HEPARIN.
• WRONG AMOUNT OF HEPARIN ,BLEEDING AROUND THE NEEDLES, NEEDLE BLEEDING AFTER HD FOR 20+ MINUTES.
• HEMORRHAGE,LOW BP,BRUISING, NOSEBLEEDS, TARRY STOOLS,PETECHIAE (PURPLE SPOTS WHERE BLOOD IS LIKED).

• FLUID OVERLOAD, NOT TAKING MEDICINE BP,ANXIETY,DDS.
• HEADACHE,NAUSEA AND VOMITING,NERVOUSNESS, MAY HAVE NO SYMPTOMS.
• TAKE A PRESCRIPTION, REDUCE FLUID AND SODIUM,ACCURATE TARGET WEIGHT, CORRECT UFG,FOR DDS SLOWER AND/OR MORE DIALYSIS,

• A TOO HIGH UFG AND UFR TAKING BO MEDICATION BEFORE DIALYSIS, CHANGE FROM SETTING TO STANDING,HEART DISEASE,DEHYDRATION.
• DROOP BLOOD PRESSURE, SWEATING OR COLD,PALLOR , YAWNING,FEELING ANXIOUS.
• ACCURATE WEIGHT,CALCULATE THE FLUID CORRECTLY,DO NOT EXCEED UFR GOAL,ASK TO THE PATIENT IF ARE TAKING BP MEDICINE, ENCOURAGE PATIENTS TO FOLLOW FLUIDS LIMITS,CHECK BP BEFORE AND THEY STAND UP.

• CHF,COPD,WRONG DIALYSATE COMPOSITION,FIRST USE SYNDROME,NON-BIOCOMPATIBLE DIALYZER MEMBRANE,EATING DURING HD,WARM DIALYSATE.
• CYANOSIS,LOW BP,RINSE IN PULSE RATE,PANTING,OXYGEN SATURATION LESS THAN 90%.  
• BLURRED VISION,CHEST PAIN,CONFUSION,CRAMPING,NAUSEA AND VOMITING,DIZZINESS,RESTLESSNESS, SHORTNESS OF BREATH.
• GIVE OXYGEN, WATCH FOR RESPIRATION,SYSTOLIC BP,PULSE RATE,OXYGEN SATURATION,MATCH BICARBONATE DIALYSATE TO  THE PATIENT,USE BIOCOMPATIBLE DIALYZER MEMBRANE,IDEAL DRY WEIGHT,USE COOLER DIALYSATE, NOT EATING BEFORE OR DURING TREATMENT.

• HYPOTENSION,A TOO HIGH UFG,AGGRESSIVE UF,CHANGES IN BLOOD CHEMISTRIES,SODIUM-POTASSIUM.
• CALLS OR CRIES,PAINFUL MUSCLE.
• PAINFUL MUSCLE CRAMPS HANDS,FEET, OR ABDOMEN.
• ACCURATE WEIGHT BEFORE TREATMENT, CALCULATE WEIGHT LOSS AND SET UFG,VERIFY MACHINE SETTINGS, DO NOT EXCEED THE UFR ,USE PRESCRIBE DIALYSATE,PATIENT NEEDS TO FOLLOW SALT AND FLUID LIMITS.

• HYPOTENSION,FOOD POISONING,DDS,PYROGENIC REACTION,ALLERGY TO DIALYZER  MEMBRANE, MEDICATION REACTION,OTHER GI PROBLEM.
• NAUSEA VOMITING, LOW OR HIGH BP,DIARRHEA AND HEADACHE.
• ACCURATE WEIGHT BEFORE TREATMENT,CALCULATE GOAL FLUID CORRECTLY, DO NOT EXCEED UFR,MEDICINE, SUGGEST TO THE PATIENT NO EAT AT DIALYSIS.

• UREMIA,DRY SKIN,HIGH SERUM PHOSPHORUS, SECONDARY HYPERPARATHYROIDISM, ALLERGY  TO MEDICINE,NEEDLE,TAPE,DIALYZER,GLOVES,BLEACH.
• REDDENED SKIN,SEEING PATIENT SCRATCHING,CRUSTING ON THE SKIN,INCREASED SERUM PHOSPHORUS LEVEL,CALCIPHYLAXIS.
• SEVERE ITCHING ALL THE TIME, OR ONLY ON DIALYSIS. 
•  KEEP THE SKIN CLEAN AND DRY,DIALYZE THE PATIENT AS PRESCRIBED, RINSE THE DIALYZER WITN EXTRA SALINE,CHANGE THE NEEDLES OR TAPE FOR ITCHING ACCESS, REFER TO THE NURSE FOR A MEDICINE REVIEW.

• SEVERE HYPOTENSION, ELECTROLYTE UNBALANCE,SEIZURE DISORDER, DIALYSATE COMPOSITION ERROR, DDS.LOW BLOOD SUGAR,AIR EMBOLISM.
• CHANGE IN LEVEL OS CONSCIOUSNESSES, TWITCHING, JERKING OF THE ARMS AND LEGS.
• CHANGE IN VISION, PANIC,TWITCHING
• AVOIS RAPID DROPS IN BUN DURING HD, MONITOR BP CHANGES,GIVE OXYGEN , ADJUST UFR,THE PATIENT NEEDS TO TAKE ANTICOAGULANT MEDICINE.

• EMPTY SALINE BAG, UNDER FILLED DRIP CHAMBERS,A DISCONNECTED EXTRACORPOREAL CIRCUIT, A NEEDLE THAT COMES OUT OF THE VASCULAR ACCESS WHILE THE BLOOD  POMP IS RUNNING. 
• CHECK THE AIR DETECTOR CLAMP IS ON,SECURE ON THE VENOUS BLOODLINE  BELOW THE DRIP CHAMBER,VERIFY THAT THE BLOOD PUMP HAS STOPPED,ASEPTICALLY DISCONNECT THE PATIENT FROM THE EXTRACORPOREAL CIRCUIT.

• HEMOLYSIS, PRE-PUMP NEGATIVE PRESSURE TO HIGH (-250MMHG),TOO MUCH BLOOD PUMP OCCLUSION,DIALYSATE CONTAINS ZINC,COOPER,NITRATES OR CHLORINE,
• TOO WARM  DIALYSATE, GERMICIDE LEFT IN REPROCESSED DIALYZER.
• STOP THE TREATMENT, DO NOT RETURN THE PATIENT BLOOD,
• DO NOT USE THE MACHINE FOR ANOTHER PATIENT.
• CHECK ALL THE PATIENTS IN CASE HEMOLYSIS IS THE CAUSE,KEEP AND BAG ALL THE SUPPLIES FROM THE AFFECTED PATIENTS TREATMENT, LABEL DO NOT DESTROY,
• ENLIST EXPERTS TO HELP TO FIND THE CAUSE.

• CLOTTING,NOT ENOUGH ANTICOAGULANT, LOW BLOOD FLOW RATE,LOW ARTERIAL DRIP CHAMBER LEVEL, ALARMS STOPPED THE BLOOD PUMP,AIR IN THE CIRCUIT.
• GIVE HEPARIN AS PRESCRIBED,RESPOND TO THE ALARMS, CHECK THE PATIENT ACCESS AND REPORT ANY UNUSUAL FINDINGS,ENSURE THAT ALL AIR IS REMOVED FROM THE EXTRACORPOREAL CIRCUIT DURING PRIMING.

• MACHINE IS UNPLUGGED,MACHINE FAILURE,POWER OUTAGE.
• KNOW HOW TO FREE THE VENOUS LINE FROM THE AIR BUBBLE DETECTOR AND HAND CRANK TO RETURN THE PATIENT'S BLOOD, IF THE WHOLE CLINIC IS AFFECTED FOLLOW YOU CLINIC POLICY AND PROCEDURE.

• EXSANGUINATION, SEPARATED BLOODLINES, RUPTURED ACCESS,  DISLODGED NEEDLE.
• STOP THE BLOOD PUMP AN CLAMP  BOTH SIDES OF A SEPARATED LINE, APPLY PRESSURE TO A BLEEDING SITE OR USE A TOURNIQUET.
• DO NOT RETURN THE PATIENT'S BLOOD IF THE LINES HAVE SEPARATED, TIGHTEN ALL EXTRACORPOREAL CONNECTIONS, IF ORDERED GIVE SALINE AND OXYGEN AND CALL 911.