Document Detail


Decreased hemodialysis circuit pressures indicating postpump tubing kinks: a retrospective investigation of hemolysis in five patients.
MedLine Citation:
PMID:  18638097     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The source of hemolysis during hemodialysis must be quickly identified to avoid life-threatening complications. At a single clinic, over a 10-day period in which 550 treatments were performed, 5 case-patients were retrospectively identified for experiencing acute hemolysis (4 deaths) from an unknown origin. The investigation focused on the postpump arterial tubing as the pressure was not monitored in this region, and the segment was shorter than required and could kink if overly stressed at bend points (i.e., tubing support clips, dialyzer inlet). To determine whether the circuit pressures indicated kinked tubing, a relative comparison between each case-patient's recorded arterial (prepump) and venous circuit pressures throughout their adverse event treatment and their immediately preceding treatment was conducted. Treatment pressure-time traces showed that sustained, significant decreases (>25 mmHg) in both of the circuit pressures occurred only on the hemolytic event dates. While direct observations of kinked tubing were not reported, the circuit pressure decreases could only be explained by severe postpump tube kinking causing a decrease in the blood flow rate. While postpump obstructions and hemolysis can occur without causing noticeable changes to the prepump arterial and venous blood line pressures (due to the highly occlusive setting of the roller blood pump), recognizing sudden and/or sustained decreases in the circuit pressures during treatment may help to prevent adverse patient events. This analysis reinforces the importance of regularly checking the blood tubing set for kinks and for monitoring the circuit pressures for atypical trends within and between treatments.
Authors:
Richard A Malinauskas
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Hemodialysis international. International Symposium on Home Hemodialysis     Volume:  12     ISSN:  1492-7535     ISO Abbreviation:  Hemodial Int     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-07-21     Completed Date:  2008-11-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101093910     Medline TA:  Hemodial Int     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  383-93     Citation Subset:  IM    
Affiliation:
U.S. Food & Drug Administration, Center for Devices and Radiological Health, Silver Spring, Maryland, USA. richard.malinauskas@fda.hhs.gov
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MeSH Terms
Descriptor/Qualifier:
Blood Flow Velocity
Blood Pressure
Equipment Failure Analysis
Hematocrit
Hemolysis*
Humans
Infusion Pumps
Kidney Failure, Chronic / therapy*
Needles
Renal Dialysis / adverse effects*,  instrumentation*
Retrospective Studies

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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