Hemodialysis Treatment Journals

iven the high comorbidity in patients on hemodialysis and therefore the complexity of the dialysis treatment, it's remarkable how rarely a life-threatening complication occurs during dialysis. The low rate of dialysis emergencies are often attributed to numerous safety features in modern dialysis machines; meticulous treatment and testing of the dialysate solution to stop exposure to trace elements, toxins, and pathogens; adherence to detailed treatment protocols; and extensive training of dialysis staff to handle medical emergencies. Most hemodialysis emergencies are often attributed to human error. A smaller number are thanks to rare idiosyncratic reactions. In this review, we highlight major emergencies which will occur during hemodialysis treatments, describe their pathogenesis, offer measures to attenuate them, and supply specific interventions to stop catastrophic consequences on the rare occasions when such emergencies arise. These emergencies include dialysis disequilibrium syndrome, venous air embolism, hemolysis, venous needle dislodgement, vascular access hemorrhage, major allergies to the dialyzer or treatment medications, and disruption or contamination of the dialysis water system. Finally, we describe root cause analysis after a dialysis emergency has occurred to prevent a future recurrence.There are currently approximately 400,000 patients with ESRD on maintenance hemodialysis (HD) in the United States (1). Each one receives dialysis at least thrice weekly (156 times per year) for a total of over 62 million dialysis sessions annually. Given the high comorbidity in patients on HD and the complexity of the dialysis treatment, it is remarkable how rarely a life-threatening complication occurs during dialysis. For example, a cardiac arrest occurs only seven times per 100,000 HD sessions (2). The low rate of major complications are often attributed to numerous safety features in modern dialysis machines; meticulous treatment and testing of the dialysate solution to stop exposure to trace elements, toxins, and pathogens; adherence to detailed treatment protocols; and extensive training of dialysis staff to handle medical emergencies. Most HD emergencies can be attributed to human error. A smaller number are thanks to rare idiosyncratic reactions. Ongoing dialysis staff training is essential to both prevent human error as well as ensure prompt and effective interventions when complications happen