Dialysis & complications during dialysis.pptx

Short description about dialysis and common complications occurred during and post-Hemodialysis. Causes, sign & symptoms, prevention and treatment of those complications.

1. Basics of Dialysis and Complication of Hemodialysis Dr Manauwar Hawari MBBS (DU)

2. Dialysis Dialysis is a process for removing waste and excess water from the blood and is used primarily as an artificial replacement replacement for lost kidney function in people with kidney failure.

3. Indication Acute indication : A cidosis (pH < 7.1 and refractory to HCO3) E lectrolytes (refractory hyperkalemia ) I ntoxication (toxic alcohols, saliyalate, lithium, etc) O verload with refractory to diuresis U remia (uremic pericarditis, uremic encephalopathy) Chronic Indication: in renal failure ( ESRD)

4. Type of Dialysis:

5. Complication of Hemodialysis : Common Complication during dialysis: Hypotension 25-60% Cardiac arrhythmias 5-60% Cramps 5-25% Nausea & Vomiting 5-15% Headache 5-10% Back pain 2-5% Chest pain 2-5% Itching 1-5% Fever 1%

6. Less Common Complication: Air embolism Seizure Hemolysis Sever dialysis disequilibrium 1 st use syndromes Acute urticaria Cardiac tamponade

7. Mechanical complication: Hemolysis Air embolus Blood leaks Clotting Power failure Dialyzer reaction

8. Complication post- hemodialysis : Hypertension/hypotension Edema Hyperkalamia Bleeding Clot of access

9. Longterm complication of Hemodialysis : AV fistula related: infection, thrombosis, aneurysm Hyperparathyroidism Anemia Fluid overload: Pulmonary edema , pleural , pericardial effusion Rest leg syndrome Peripheral neuropathy Constipation Itching Sleep problem Sexual dysfunction MI, CVA Blood infection: HIV, HBV, HCV, CMV

10. Hypotension: Causes Sign & symptom How to prevent How it’s Treated Excessive UF Too much Anti-HTN medicine Heart disease Slow or sudden drop in BP Nausea Vomiting Yawning Flush or warmth Fainting Cramping Ears ringing Correct dry weight Withhold BP meds Use sodium profiling Longer, slower dialysis Turn off UF Put patient in Trendelenburg position Give normal saline or other volume expander Sometime medicine: tab Midodrine (30min before dialysis)

11. Muscle Cramps: Causes Sign & symptom How to prevent How it’s Treated Excessive fluid removal Osmotic gradient Changes in blood sodium level Severe muscle pain( esp. in calf muscle), mainly toward end of dialysis Fluid limits for patient Sodium limits for patients Sodium modeling Slower UF Check dry weight Stop UF Hypertonic saline Or Normal saline Massage Continue HD at reduce UF or No UF Return blood

12. Hypoglycemia (Blood sugar < 70 mg/dl): Causes Sign & symptom How to prevent How it’s Treated Excessive UF Anti-DM medicine pre –dialysis or under insulin Not take food Sometime Correlate with Slow or sudden drop in BP fainting Correct dry weight Withhold Anti-DM pre-dialysis Longer, slower dialysis Administer 50 ml of 25% Dextrose IV If not ok, another 100 ml of 25% Dextrose IV

13. Headache: Causes Sign & symptom How to prevent How it’s Treated Disequililibrium Fluid shifts Dialyzer type (no reuse) High BP Caffeine with drawal Tension Patient complain Short frequent treatments Slow UF Rinse dialyzer well Coffee Reassure Acetaminophen (PCM) Try different dialysers

14. Angina: Causes Sign & symptom How to prevent How it’s Treated Low BP Anemia Heart Disease Anxiety Chest pain cold Sweating May have trouble breathing Assess dry weight Accurate UF Hb % in target range Stop treatment Oxygen Nitroglycerine Minimize UF Treat low BP

15. Fever and chills: Causes Sign & symptom How to prevent How it’s Treated Infection Contaminated dialysate or dialyzer Too cold dialysate Fever Shaking Patient complain of feeling cold Proper water treatment Correct reuse steps Aseptic technique for dialysis Inj. Avil 1 amp + inj. Hydrocort for chill Tab PCM for fever Stop treatment if not control and assure source of infection Antibiotics

16. Breathlessness: Management: Make the guest sit up if uncomfortable lying down Connect Multiparamonitor and assess SPO2 & Heart Rate Administer 2 liters of oxygen through mask Check BP

17. Hypertension: Causes Sign & symptom How to prevent How it’s Treated Fluid overload Inadequate BP Meds Renin response Dizziness Headache Neausea Vomiting Edema High measured BP Control fluid and sodium Accurate dry weight Adjust BP meds Longer, slower dialysis Remove fluid Review BP meds More dialysis Nephrectomy (Last resort)

18. Blood Loss: Causes Sign & symptom How to prevent How it’s Treated Bloodline separation Dislodged needle Cracked dialyzer Major blood leak See blood on clothing or floor Blood leak detector alarm A/V pressure alarm Low BP Keep patient accesses in view Ensure tight line connections Inspect dialyzer Clamp lines Control bleeding Normal saline Transfusion

19. Hemolysis: Causes Sign & symptom How to prevent How it’s Treated Hypotonic dialysate Too hot dialysate Pressure in bloodline Disinfectants Bright red blood Chest tightness Shortness of breath Back pain Low BP Low Hb % Seizures Cardiac arrest Proper water treatment Maintain dialysis machines Test before treatments Verify absence of sterilent Clamp venous line Discontinue HD immediately as it may lead to cardiac arrest, dysrhythmias, seizures Connect multi- parammonitor and monitor vital signs; look for dysrhythmias, hypotension and shortness of breath Do not return blood Administer Oxygen Replace volume and/or blood transfusion if symptoms are severe

20. Puritus : Causes Sign & symptom How to prevent How it’s Treated Uremia (high BUN) High phosphorus Calcium phosphate deposition Contact allergy ( e.g.;bleach ) Sever itching Red skin Crusting on skin Keep skin clean Phosphate limits, binders Put sheet on chair Test for heparin allergy Adjust binders Provide adequate dialysis Switch heparin (pork to beef or vice versa or use citrate)

21. Convulsions / Seizures: Causes Sign & symptom How to prevent How it’s Treated Disequilibrium Electrolyte imbalance Hypotension Drug reaction Seizure disorder Hemolysis Jerking of arms and legs Eyes roll back Avoid rapid BP drop Minimize BUN drop (new pt) Use right dialysate Stop Dialysis immediately Turn the head to his/her left side. Use suction apparatus for Oral suction Give 10 liters of oxygen Place Airway to prevent tongue fall back. Connect Multi- param monitor Administer Inj. Lorazepam 2 mg IV Check pulse, BP, respiratory rate Shift to the ICU

22. Air embolism: Causes Sign & symptom How to prevent How it’s Treated Air bubble detector is broken or not armed SOB Coughing Turning blue Confusion Seizure Death Arm Air detector Check all tubing connections Clamp saline bag Stop Dialysis immediately Place patient in Trendelenburg position on his/her left side Connect multi-parameter monitor to assess vital signs Connect oxygen Shift patient to ICU

23. Cardiac arrest: Causes Sign & symptom How to prevent How it’s Treated Sever hypotension Electrolyte imbalance (k+) Arrhythemia Myocardial infraction Air embolism Blood loss No pulse No breath Flat ECG Check vitals at treatment Use right dialysis Stop HD immediately Start CPR

24. Anaphylaxis: Causes Sign & symptom How to prevent How it’s Treated Allergy to ethylene oxide Medication recation Bronchiospasm Anxiety SOB Facial swelling Cardiac arrest Death Rinse dialyzer well Test dose of high-risk meds ( e.g ; IV Iron) Benadryl or epinephrine Stop treatment DONOT return blood Start CPR if needed

25. Dialysis Disequilibrium Syndrome: Causes Sign & symptom How to prevent How it’s Treated Too rapid removal of BUN (caused by cerebral edema due to osmotic influx of water into brain after removal of urea by dialysis before equilibration across cell membranes occurs) Headache Vomiting High BP Restless Blurring vision Convulsion Coma Death Short , frequent dialysis Concurrent dialysate flow Stop dialysis Symptom self limiting after few hrs With sever fitting , give IV Mannitol (12.5g) or hypertonic saline (5ml of 23% )

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