Asia Renal Dialysis Center

8/8/2019 Asia Renal Dialysis Center

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Complications & Management of Hemodialysis:

1)Muscle cramps Due to excessive fluid removal related to dialysate Na

concentration associated with hypocalcemia or hypokalemia.

S/S : Painful muscle spasms

Tx: Stop ultrafiltration, Bolus with dose osmotic agent (D50, Mannitol, 100cc NS)

Extend cramped muscle by pressing againsts the muscle with your hands or legs.

2)Chest pain Due to anemia, cardiac disease, coronary artery spasms, severe

vascular volume depletion

Txs: Discontinue of dialysis of severe administration O2 of drugs as ordered,

decrease UF rate, Assess & treat volume depletion.

3)Hypotension excessive or inaccurate volume depletion, consumption of largemeals on dialysis, anemia, and hypertensive meds., Unstable cardiac status,

hypoalbuminemia, incorrect UF rate.

S/S: Anxious feelings, Nausea & vomiting, Dizziness or faint feeling, Pallor, Yawning,

Hot feeling, Sweating, Tachycardia, LOC.

Txs: Decrease or discontinue UF, place in trendelenburg position, Infuse 100-200cc

of NSS, D50, Albumin or hypertense saline. Chech B.P. every 5 mins. & notify

doctor.

4)Nausea & Vomiting Due to hypotension disequil, too rapid UF, Meds, Allergy,

Flu.

Txs: Stop UF, Infuse 100 cc of NSS, Check B.P.

5)Headache Due to disequil, hypertension, anxiety

Txs: Stop UF for 5 mins, Pain reliever

6)Disinfectant reaction Inadequate rinsing of a dialyzer, disinfectant present in

the H2O system.

S/S: Paint at the site, Chest & back pain, S.O.B., Irregular pulse, dry mouth, thick

tongue

Txs: Stop UF, Infuse 100cc NSS, Check B.P., Check V/S, Recirculate the blood for 15

mins, Check blood lines for brownish color, if present discard the blood.

7)Dysrhytmias- electrolytes and PH changes, underlying heart disease, removal of

antiarrhytmic drugs during dialysis.


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Txs: Anti - arrythmia drugs as prescribed, Discontinue if severe, Monitor with EKG if

possible

8)First use or allergic dialyzer reaction complement activation pathway by

new cellulosic membrane, reduce with reuse cellulosic membrane.

S/S: Back pain, chest pain, hypotension

Txs: Use of synthetic membrane, reuse of cellulosic membranes with agents which

removes the protein coat on the membrane.

9)Hypoglycemia Decreasein blood sugar

S/S: B.P. may or 20-30mmHg, H.R. may or , Sweating, Cold clammy skin,

Slurred speech, Tremor progress convulsion, Headache, Nervousness,

Restlessness, Irritability

Txs: Check Bld. sugar, Administer sugar by mouth or IV depending on doctorsorder.

10)Hyperglycemia Increase in blood sugar, too much insulin or eating too many

carbs.

S/S: H.R. is rapid, Deep respiration, Thirst, Hot, Dry flushed skin, Vomiting,

Abdominal pain, Drowsiness, Flushed face

Txs: Check Bld. sugar, Notify the doctor

11)Seizures Hypotension, reaction to chemical agent, electrolyte imbalance,

dialysis disequil, dialysate composition errors

S/S: Change in LOC, Jerking movement of arms and legs

Txs:Maintain airway, Stop UF, Turn down blood, Infuse Saline, Notify doctor

12)Hemolysis- Due to hypertonic or hypotonic saline, over heated dialysate, blood

pump is not calibrated properly, chloramine in the H2O supply, disinfectant in the

dialyzer

S/S: Chest pain, Dyspnea, Hypotension

Txs: Discontinue dialysis, Do not reinfuse hemolyzed blood, Monitor V/S, Notify thedoctor, O2 administration, Clear blood in the venous blood line (Transluscent),

Localized burning pain in circulatory access return to site, If hypertensive dialysate,

disrythmias acute decrease in hct., Hyperkalemia

13)Cardiac Tamponade Due to acute hemorrhagic pericarditis, Chronic

pericarditis, Constrictive pericarditis.


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S/S: Central chest pain worse when supine, improves when upright pericardial

friction rub

Fever, Hypotension, Distended neck vein, Muffled heart sound, Absent apical pulse.

Txs: Discontinue hemodialysis if severe, Minimal or no anti-coagulant, Surgical

intervention may be required

14)Anaphylactic Reaction Maybe hypersensitive to ETO used to sterile the

dialyzer, most likely with cuprophane membranes.

S/S: Acute bronchoconstriction, Initial feeling of uneasiness followed by agitation,

S.O.B., coughing, wheezing urticurtia, faced edema, flushing, respiratory arrest,

vasodilation & hypotension or hypertension.

Txs: Use of another dialyzer

15)Air Embolism Defective air detector

S/S: Visualization of air in the system, Chest pain, Dyspnea, Coughing, Cyanosis,

Visual problem, Confusion, Coma, Hemiparesis, Death

Txs: Discontinue Hemodialysis, Turn to the Left side or trap the air in the apex of

Right ventricle, O2 (4-6L/min), Check V/S, Notify & carry out order.

16)Cardiac Arrest & Respiratory Arrest Due to electrolyte imbalance,

Dysrhytmias, M.I., Cardiac Tamponade, Large air embolism, hemolysis,

hyperthermia, etc.

S/S: () apical & carotid pulse, Lack of spont., Unresponsive, Abnormal heart beat or

cardiac monitor

Txs: Assess for signs & symptoms & call for assistance, Trendelenburg position,

Attempt to arouse the patient with verbal stimuli, Administer O2, Return blood, Get

the emergency cart, Suction, Call ambulance, Give meds as ordered, Assists with

respi with ventilator bag & commence CPR if cardiac arrest occurs, Transfer to

hospital.

17)Fever & Chills

-reduce Temp. momentarily, Adminiter anti histamine (Hydrocortisone),

Discontinue if severe, Notify


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18)Disequilibrium Syndrome Drastic change in ECF fluid.

S/S: Headache, Nausea & Vomiting, Tremors, Seizure

Txs: BFR, Hypertonic saline if cramps persist, Gentle Hemodialysis for 1st 1 2

hours.

19)Hematoma Hemodialysis, STOP if severe

- Surgical drainage if a threat to the AV fistula

-Avoid hemodialysis at least 24hrs. post operative.

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Asia Renal Dialysis Center