UNCONTROLLED WHEN PRINTED
Quick Chart
Introduction
- For the management of home haemodialysis emergencies
Clinical Presentation
- Errors made in connecting dialysis, or a fault with the dialysis machine, may cause an air embolism to be administered through the patient’s fistula, causing acute neurological symptoms, including:
- Stroke
- Seizure
- Unresponsiveness
Exclusion Criteria
Exclusion Criteria
Risk Assessment
- Early disconnection from the dialysis machine is vital, but be prepared for haemorrhage from fistula site
- Take care to avoid unnecessary contact with blood as serum hepatitis is common in dialysis patients
- Inspect venous return lines of shunt for air bubbles/pockets
- Document type of dialysis machine
Management
Primary Care
- Primary survey
- Place patient in lateral position
- Manage airway as required
- Suction as required
- OPA/NPA as indicated
- Oxygen as per CPG & supportive ventilation as required
- Stem bleeding with pressure and elevation
- If required, manage seizures as per CPG
- Turn off power to the dialysis machine at the wall outlet
- Clamp both blood lines about 25cm from the arm
- Cut the lines between the clamps and the machine with scissors
- Complete Vital Sign Survey
Intermediate Care (EMT / Level 2)
- Stem bleeding with Combat Application Tourniquet (CAT) as required
- Apply cardiac monitor if trained and authorised
- Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
- Transport Priority 1 if patient time critical, pre-notifying receiving facility
Advanced Care (AP)
- Stem bleeding with Combat Application Tourniquet (CAT) as required
- Apply cardiac monitoring
- Establish vascular access
- Consider obtaining prehospital blood sample
- Consider fluid therapy as per CPG
- Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
- Transport Priority 1 if patient time critical, pre-notifying receiving facility
Critical & Extended Care (CCP, PSO)
- RSI with mechanical ventilation as indicated
- Replace blood product as indicated
Additional Information
- Peritoneal dialysis emergencies are usually associated with sepsis. For these types of dialysis emergencies treat as per the Septic Shock CPG 4.5.5
References
References
Document Control
Directorate
Clinical Services
Responsible Manager
Head of Clinical Services
Published Date
Review Date
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