Diagnosis, Treatment, and Prevention of Hemodialysis Emergencies

Abstract

Given the high comorbidity in patients on hemodialysis and the complexity of the dialysis treatment, it is remarkable how rarely a life-threatening complication occurs during dialysis. The low rate of dialysis emergencies can be attributed to numerous safety features in modern dialysis machines; meticulous treatment and testing of the dialysate solution to prevent exposure to trace elements, toxins, and pathogens; adherence to detailed treatment protocols; and extensive training of dialysis staff to handle medical emergencies. Most hemodialysis emergencies can be attributed to human error. A smaller number are due to rare idiosyncratic reactions. In this review, we highlight major emergencies that may occur during hemodialysis treatments, describe their pathogenesis, offer measures to minimize them, and provide specific interventions to prevent catastrophic consequences on the rare occasions when such emergencies arise. These emergencies include dialysis disequilibrium syndrome, venous air embolism, hemolysis, venous needle dislodgement, vascular access hemorrhage, major allergic reactions to the dialyzer or treatment medications, and disruption or contamination of the dialysis water system. Finally, we describe root cause analysis after a dialysis emergency has occurred to prevent a future recurrence.

Dialysis‐associated allergic reactions during continuous renal replacement therapy and hemodialysis: A case report

“…1 However, clinical presentations vary, and the offending allergen may be challenging to identify. The majority of cases relate to ethylene oxide (EtO)-sterilized equipment, cellulose membranes and medications.…”

Identification and Chemical Characterization of Insoluble Contaminants in Hemodialysis Water Treatment

“…The low rate of major complications can be attributed to numerous safety features in modern dialysis machines; meticulous treatment and testing of dialysate fluids to prevent exposure to trace elements, toxins, and pathogens; adherence to detailed treatment protocols; and, extensive training of dialysis staff to handle medical emergencies. Most hemodialysis emergencies can be attributed to human error [11]. Patients on hemodialysis are exposed to around 120 L dialysate water (e.g., dialysate flow 500 mL/min for 240 min) during an average dialysis session [12].…”

Haemolysis in haemodialysis

“…The variable blood flow within the extracorporeal circuit itself, with higher rates at the center of the laminar flow compared with the edges results in differential forces and shear stress …”

“…Mechanical obstruction can occur at various points along the extracorporeal circuit including the needle, catheter, tubing and blood pumps. Many studies describe outbreaks of haemolysis secondary to kinked tubing, and some report on malocclusion at the level of the blood pump …”