Table 1.
| Type of Emergency | Estimated Frequency, per Million HD Sess ... | Refs. |
| Dialysis disequilibrium | ||
| Air embolism | 8.5–33 | Tennankore et al. ( 31 ), Wong et al. ( ... |
| Hemolysis | ||
| Vascular access hemorrhage |
What is hemolysis and how to prevent it?
- Avoid line draws---IV devices are notorious for hemolyzing red cells. ...
- Avoid vigorous mixing---think of red cells as fragile crystal orbs that fracture with the least amount of disturbance;
- Avoid excessive pulling pressure when using syringes---red cells don't tolerate the excessive turbulence from forcefully withdrawing the plunger of the syringe;
Why is chloramine harmful for dialysis patients?
Chloramines, derived from chlorine and ammonium, are added to water as disinfectants and may contaminate dialysis fluid and enter the blood of dialysis patients causing haemolytic anaemia. Depending on the number of chlorine atoms that bind to nitrogen in exchange for hydrogen, monochloramines, dichloramines or trichloramines are formed [ 1 ].
Why is sodium bicarb given to dialysis patients?
When sodium bicarbonate is added to the mix, it helps counter acid build-up by creating a buffer against the acids which are not excreted, and over time, may help to stave off and reverse its very damaging effects on the kidneys. The Proof Is In The Pros
What is the classic sign of hemolysis?
hemolytic anemia What are the classic clinical manifestations of hemolytic anemia? jaundice, scleral icterus, leg ulcers (rarely), bilirubinate gallstones, splenomegaly, acute crisis (aplastic crisis or megaloblastic crisis), and hemoglobinuria
What are the common causes of hemolysis?
Hemolysis resulting from phlebotomy may be caused by incorrect needle size, improper tube mixing, incorrect filling of tubes, excessive suction, prolonged tourniquet, and difficult collection.
Which issue is a probable cause of hemolysis in dialysis patients?
Patient-specific Factors Other causes of hemolysis include medications, co-existing illnesses, and electrolyte abnormalities. Medications are a well-known cause of hemolysis in dialysis patients, especially in those with glucose-6-dehydrogenase deficiency.
What causes blood to hemolysis quickly?
Certain conditions can cause hemolysis to happen too fast or too often, including the following: autoimmune conditions. Bone marrow failure. Complications from blood transfusions.
What happens if too much fluid is removed during dialysis?
If too much fluid is removed and a person goes below their dry weight, a patient may experience dehydration causing: Thirst. Dry mouth. Lightheadedness that goes away when laying down.
Can you reverse hemolysis?
The result is an extremely fast destruction of red blood cells, which can be lethal. This is why healthcare providers need to carefully check blood types before giving blood. Some causes of hemolytic anemia are temporary. Hemolytic anemia may be curable if a doctor can identify the underlying cause and treat it.
How can you prevent hemolysis?
Best Practices to Prevent HemolysisUse the correct needle size for blood collection (20-22 gauge).Avoid using butterfly needles, unless specifically requested by patient.Warm up the venipuncture site to increase blood flow.Allow disinfectant on venipuncture site to dry completely.More items...•
Can hemolysis cause death?
Hemolytic anemia itself is rarely fatal, especially if treated early and properly, but the underlying conditions can be. Sickle cell disease. Sickle cell disease decreases life expectancy, although people with this condition are now living into their 50s and beyond, due to new treatments.
What happens during hemolysis?
Hemolytic anemia is a disorder in which red blood cells are destroyed faster than they can be made. The destruction of red blood cells is called hemolysis. Red blood cells carry oxygen to all parts of your body. If you have a lower than normal amount of red blood cells, you have anemia.
What are the symptoms of haemolysis?
Haemolysis can manifest with non-specific signs and symptoms including but not restricted to hypertension, nausea, pain (abdominal, chest, back) and dyspnoea.
Is hemolysis rare in haemodialysis?
Haemolysis in haemodialysis. Haemolysis in haemodialysis, although rare in current times, is associated with significant mortality and morbidity. As such prompt recognition, treatment, analysis of root cause and correction of underlying causative factors is crucial.
Is haemolysis a morbidity?
Haemolysis in haemodialysis, although rare in current times, is associated with significant mortality and morbidity. As such prompt recognition, treatment, analysis of root cause and correction of underlying causative factors is crucial. Dialysate, extracorporeal circuit and patient related factors all contribute to haemolysis risk.
What causes blood clots in the capillaries?
Hemolytic uremic syndrome (HUS) is a diseases in which blood clots within the capillaries. Causes associated with HUS include: E. coli, birth control pills, pneumonia, medications such as chemotherapy, Ticlid, and quinine. Symptoms of HUS include: gastroenteritis, abdominal cramping, vomiting, and bloody diarrhea.
Why do red cells break down?
Red cells may break down due to mechanical damage, such as from artificial heart valves or heart-lung bypass; or they may be destroyed due to defects in the cells themselves. Medications that have been associated with hemolysis include acetaminophen, penicillin, and other pain medications.
What is the term for the destruction of red blood cells?
Hemolysis is the destruction of red blood cells. Hemolysis can occur due to different causes and leads to the release of hemoglobin into the bloodstream. Normal red blood cells (erythrocytes) have a lifespan of about 120 days. After they die they break down and are removed from the circulation by the spleen.
What is the disorder where the alpha globin protein is underproduced?
Alpha thalassemia is a disorder in which the alpha globin protein is underproduced. There are two pairs of genes that carry the code for the alpha chains of hemoglobin. When one gene is impaired, that person is in a carrier state and suffers no medical problems.
How does CMV spread?
Cytomegalovirus (CMV) is a virus that is spread from person to person via spit, semen, vaginal secretions, urine, blood, sexual contact, breastfeeding, blood transfusions, organ transplants, and breast milk. Symptoms of CMV include fatigue, swollen glands, fever, and sore throat. You can take precautions to prevent CMV such as washing hands frequently and thoroughly and using condoms. If you work in a day care center, wash your hands thoroughly after contact with body secretions, and avoid oral contact with objects covered in saliva. Individuals with HIV infection are at most risk of contracting CMV.
Is thalassemia a genetic disorder?
Thalassemia is not just one disease but rather a complex series of genetic (inherited) disorders all of which involve underproduction of hemoglobin. Beta thalassemia major symptoms include pale skin, irritability, growth retardation, swelling of the abdomen, and jaundice.
Can G6PD cause hemolytic anemia?
Hemolytic anemia caused by G6 PD deficiency generally occurs after exposure to malaria medications, antiitching drugs, and fava beans. Pneumonia and other infections can also precipitate hemolytic anemia in individuals with G6PD deficiency. Treatment is generally discontinuing the drug or compound treating infection.
Does this patient have intrdialytic hemolysis?
High blood flow rate, single-needle dialysis, small-gauge cannula, kinked blood line, highly negative arterial pressure, offset blood pump
How to utilize team care?
1. Specialty consultations: Code team (if patient develops cardiac arrest); hematology (if recurrent episode)
Are there clinical practice guidelines to inform decision making?
2010 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science. (Published by American Heart Association)
What is the evidence?
Sayre, MR, Koster, RW, Botha, M, Cave, DM, Cudnik, MT, Handley, AJ, Hatanaka, T, Hazinski, MF, Jacobs, I, Monsieurs, K, Morley, PT, Nolan, JP, Travers, AH. “Adult Basic Life Support Chapter Collaborators.
