Dialysis is a common treatment used to treat those who have end stage renal disease. However, there are instances when a patient may experience side effects from the treatment. The complications brought about by dialysis can be mild or severe, depending on the patient’s condition. The majority of these side effects can be managed as long as the patient strictly follows the healthcare team’s food and fluid intake recommendations. Whether or not the patient is carefully following their dietary and fluid restrictions, a dialysis technician should possess vital knowledge about dialysis and kidney function. Since dialysis makes the difference between life and death for those who suffer from renal failure, a good eye for detail is what a dialysis technician should have.
Low Blood Pressure
The most common complication to watch out for as a dialysis technician is hypotension. Patients can experience abnormally low blood pressure when too much fluid is removed from the blood during hemodialysis. When blood pressure drops, dizziness and vomiting will then develop. Dialysis technicians should make a good habit out of regularly checking on their patient’s vital signs, making sure that any abnormalities or discomforts are prevented, or, at least, relieved. Medications for high blood pressure are not usually taken before treatment for this reason.
In some cases, patients may also experience their muscles cramping while undergoing hemodialysis. Muscle cramps may present in different parts of the patient’s extremities when fluid is taken out of the body at a fast rate during dialysis. When too much fluid is removed, muscle cramps may also develop. Cramping is a natural reaction exhibited by muscles. Aside from medications that can be prescribed by the doctor, a dialysis technician can also recommend some remedies to control muscle cramps, such as stretching, massaging, or regulating the rate of the dialysis machine.
A patient with end-stage renal disease can either have a fistula or a graft as vascular access designed for long-term use. Unfortunately, this can become infected or inflamed when poor hygiene is present. The dialysis technician should practice aseptic technique and proper disinfection of access site prior to cannulation to help prevent infection. It is very important for dialysis technicians to perform procedures under sterile conditions.
On the other hand, an access can also become clotted with blood. Since clotting prevents the blood from flowing through, a patient won’t be able to get dialysis treatment unless this is prevented by the dialysis technician. The healthcare team should always remind the patient to monitor the access daily by checking for the thrill to ensure it is functioning correctly. A thrill is a palpable murmur in the fistula or graft.
Hemodialysis may also cause itchy skin, which is believed to be a natural reaction to high phosphorus levels in the blood. Since phosphorous is poorly removed by dialysis, foods high in this natural mineral are restricted on the renal diet. Patients are prone to dry skin, which can also be the cause of itching. As a dialysis technician, advise the patient to avoid hot showers and harsh soaps, and use moisturizing creams, if possible.
On the psychological side, patients may also deal with anxiety, depression and a change in self-image. Because dialysis technicians work closely with patients who are chronically ill, they should have compassion and empathy, aside from the manual dexterity required by the job. While the job description of a dialysis technician may include multiple roles, being the primary direct care giver for patients undergoing dialysis treatments is the most important one of all. Learning how to respond to the emotional needs of patients is truly expected.
In some cases, blood may leak during treatment when an internal membrane ruptures. The blood leak detector is the dialysis technician’s first line of defense to prevent this complication. When checking the dialysate outflow for traces of blood, the detector sends a beam of light through the used dialysate into the photo cell. The amount of blood detected can vary greatly, with some that cannot be seen by the human eye. Ideally, bacteria are too large to pass through the tiny holes in the dialyzer’s hollow fibers. When the fiber is broken, causing blood leak, bacteria could transport from the dialysate into the patient’s blood stream. For this reason, the physician may order blood cultures and prophylactic antibiotics.
An air embolus is a blockade of gas bubbles in the bloodstream. Usually, air bubbles carried by the blood stream can block small vessels. Air embolism is the most common complication a dialysis technician can prevent. It’s normally caused by unarmed air detectors, empty saline bags, and the separation of the arterial line from the needle or catheter hub. Unclamped catheter lumens, under-filling of drip chambers and poor priming can also cause air embolism. The signs and symptoms of this complication may depend on the patient’s position. However, air in the venous line will be very visible. Difficulty in breathing and coughing, as well as chest tightness and pain, are usually present when there are gas bubbles in the bloodstream. When a blue or purple coloration appears on the patient’s skin or mucous membranes, the dialysis technician should instantly administer oxygen and call for help.
Local power outage, though fairly uncommon, can still cause complications. Once the machine power alarm sounds, the dialysis technician should determine the cause of failure and remove the venous line from the line clamp. It is very important to monitor the venous line for air once it is removed from the line clamp. Since air bubbles can form when tubing are exposed, be sure to clamp them. Only continue treatment when the power is stable. The dialysis technician should then recheck machine settings and ensure the venous line is reinserted into the line clamp.
Dialysis Disequilibrium syndrome (DDS)
The earliest sign of DDS is constant headache. This syndrome is caused by a sudden increase in brain water. During dialysis, plasma solutes tend to be removed too rapidly, which makes the solute concentration in the brain higher. Because of this, water shifts by osmosis from the plasma into the brain tissue. The sudden changes in the pH of the brain fluid play a big role in this complication. New patients or those who have skipped treatments are at higher risk for acquiring this disorder. Decreasing efficiency of solute removal, blood flow or dialysate flow usually does the trick. But if left untreated, DDS can lead to high blood pressure, nausea, restlessness, coma, or death.
Seizures are changes in the brain’s electrical activity. Many different things can occur during a seizure, but the most common of which are the change in level of consciousness of the patient and uncontrolled convulsions. Seizures can be caused by varying factors. To name some, hypotension, electrolyte imbalance, DDS, and reactions to chemicals can complicate into a seizure. The best intervention a dialysis technician can implement is to protect the patient from harm. Administer oxygen only when indicated. If hypotension is present, a saline bolus may be given. If no positive response occurs, immediately discontinue dialysis.
Fever and Chills
Fever and chills are common symptoms associated with systemic or access infections. Infections, on the other hand, develop when the blood or dialysate compartments are contaminated. To prevent fever and chills, proper water treatment is customary, as well as the proper disinfection of equipment.
Some patients may be hypersensitive to ethylene oxide, or the dialyzer membrane material itself. For this reason, cellulose-based dialyzers may not be prescribed by the physician. There are instances, however, when dialyzer reactions occur only during 15-30 minutes into the treatment when using a new dialyzer. This is commonly known as “first use syndrome,” where back pain, chest pain, hypotension, itching, or chest tightness manifests. To prevent any unwanted reactions, the treatment may be stopped if it’s proven to cause an allergic response.
Hemolysis is the breakdown of the red blood cell. It can be caused by a poorly calibrated blood pump. Since red blood cells naturally carry oxygen, they can easily burst when exposed to high temperatures. When the dialysate temperature is too high, it can cause red blood cell destruction, causing anxiety, restlessness, pain in access arm, nausea, vomiting, abdominal cramping, chest tightness and dyspnea. If left untreated, hemolysis can lead to possible death. When the associated signs or symptoms are manifested by the patient, the dialysis technician should immediately stop the blood pump, clamp lines, and administer oxygen.
A severe constricting chest pain may be felt by the patient during treatment if hypotension, severe anemia, or an underlying cardiovascular disease is present. Due to the severe pain, the patient may have difficulty in breathing. To prevent angina, the dialysis technician may reduce blood flow, and administer normal saline and oxygen for hypotension.
Large blood loss, which can occur during treatment, can cause an abrupt loss of heart function in a patient. If no pulse is detected, and there’s lack of respiration, dialysis technicians should immediately call for help and initiate CPR. If possible, return blood while still maintaining needle for saline infusion. While this complication may require utmost care and monitoring, the dialysis technician should have the presence of mind to make sure other patients are monitored as well.