1 environmental complications

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ChemicalsinDialysis



Cause S & S Prevention Treatment Too high QB for Foam in Blood ID Access Correct cause of

access, Loose Problems air entering

connection, Low Air/Foam system

Drip Bulb, connections Remove air from

Inadequate system, by

rimin rocedure recirculation if

NS bag empty necessary



Cause

Inadequate

anti

coagulation,low blood

flow rates, air

in s stem

S & S

Blood darker

than normal,

VP or TMPalarm, poor

rinseback

Prevention Treatment Adequate

heparinization

maitntain prescribed

blood flow,

avoid air in

blood

Change out

blood line or

dialyzer asneeded, re

assess anti

coa ulation

needs



de

Cause S & S Prevention Treatment Excessive UF, Gradual or Correct Turn off UF,

Anti- sudden drop EDW, put patient in

trendelenburg,h ertensives in BP N/V Correct regive NS ofPoor Cardio Yawning, dialysis wt.,other volumevascular status flush or with-hold BPex ander

warm me s, usefeeling profiling



Cause S & S Prevention Treatment Fluid Dizziness, Control fluid Remove

Overload, H/A, N/V, and NA, fluid, review

Inade uate Edema Hi h EDWAccurate

BP Meds, measured BP EDW, Adjust review BP

Renin BP Meds Meds,

response ep rec omy(last resort)



Cause

Excessive

fluid

removal

Osmotic

gradient

S & S

Sever pain in muscles, calf muscles most often

Prevention Treatment Diet and

fluid

restrictions

NA

modeling

Hypertonic

Saline, NS,

Return

blood,

massage

musc e



Cause S & S Prevention Treatment Hypotension, Pt complaint, Close Minimize UF,

DDS, vomiting assessment of trendelenburg,

Microbiologic vital signs, NS,contamination don’t eat on medications

the run, avoid

DDS



Cause

DSS, Fluid

shifts,

Caffeine,

withdrawal,

anx e y

S & S Prevention Treatment Pt Depends on Acetaminophen

Complaint cause

pain



Cause S & S Prevention Treatment

Hypotension, Chest pain Asses EDW, D/C Dialysis,

Anemia, accurate UF, O2, nitro,

Cardio- maintain Hct. minimize

vascular UF, treat

disease, hypotension

anx e y



Cause

Micro

biological,

either sepsisor endotoxin.

Exposure

from Reused

Dialyzer,

water, or

S & S

Fever, rigors,

feels cold,

hypotension.Probably

pyrogenic if

tem increases

by 2 deg, with

absolute > 100

Prevention Treatment Proper H2O D/C dialysis,

treatment assess source

maintenance of infection,and reuse administer

procedures. antibiotics

Ase tic

technique

when

dialysis



DialysisDis

‐

equilibriumSyndrome

(DDS)

Cause S & S Prevention Treatment Too rapid HA, N/V, Short, Termination

removal of hypertension, frequent of treatment

cells swell convulsions, concurrent

from coma, death dialysate

osmos s ow



Cause S & S

Complement CP, Back

activation by Pain, ,

membrane or SOB, N/V

ETO

Prevention Treatment Reuse dry D/C dialysis,

dialyzer, use change

sterilized order

with Gamma

Radiation



Cause S & S

ETO Bronchio

sensitivity,

reaction

restriction,

SOB, facial

edema,

resp ra orydifficulty,

cardiac

arrest, death

Prevention Treatment Rinse

dialyzer well,

high risk

medication

ron

Manage

S&S,

dialysisi, DO

NOT

BLOOD



Cause S & S

DDS, Jerking of

Electrolyte arms and

Hypotension, easily

Medication swallow

reac on ongue, eyesroll back

Prevention Treatment Avoid rapid Anti-

BP drop, convulsive

BUN drop

(new

pa en s , proper

dial sate

composition



Cause

Electrolyte imbalance

,

arrhythmia,

MI, Air

em o sm,exanguination

S & S Prevention Treatment No pulse, no Prevent CPR, Return breath, causes Blood,

to EKG blood line

and machine



Hemolysis Cause

HypotonicDialysate,

Dialysate,

Pressure inoo nes,

Disinfectants,

Copper,

nitrates

S & S

Tightness inChest, SOB,

,

Hypotension,

Cherry Popco ore oo ,

decrease

Hct/Hgb,

Seizures,cardiac arrest

Prevention Treatment Proper water Clamptreatment, Venous line,

,

dialysis DO NOT

machines, test RETURNe ore ,

treatments, Draw K+ &

verify absence Hct, Give O2,

of sterilant replacevolume,

Dial sis



Cause

Low flow in access, too Flow Rate,

Needles too

c osetogether,

Lines

hooked up

backwards

S & S

Dark red

blood,

blood

lightens after

o us,increased

clottin

Prevention Treatment Ensure

proper

and hook up

of lines,

on oraccess

function

Resolve

cannulation

issues,

surgically

res ore orreplace

access



Cause

Improper

Cannulation,

Movement

during

dialysis

S & S

Pain,

swelling,

bruisin

change in V

or A Pressure

rea ng

Prevention Treatment Proper

Cannulation,

Minimize

movement

during

a ys s

Remove

needle, put

ice on site

restick away

from

n ra on



AccessInfection

Internal

Cause S & S Prevention Treatment Break in Redness, Good Draw blood

Aseptic Swelling, technique, cultures,

’

Poor from site, inflamed Surgical

Hygiene, Fever, Chills area, Pt revision

ee ng e uca onfrom another

infection



Cause

Poor Hook

up technique,

of fibrin

sheath,

unne , orexit site

AccessInfection

CentralCatheters S & S Prevention Treatment

redness, Aseptic Culture site,

swelling, Technique, Antibiotics,

and drainage, catheter care, replacement

fever, exit antibiotic

s e warm . o n men



HazardousChemicals



Mosthazardouschemicalsindialysis aredisinfectants

Adisinfectantisachemicalthathas ,

butnotallof the microorganismspresent.



Whyaredisinfectantsso importantin dialysis?

Disinfectants………..• Minimizedialysispatient’sexposureto

toxinsorbacterialb ‐ roductsinwateror

dialysisequipment•



• thedisinfectionprocesswillbeineffective • andthedisinfectantsthemselvescan



CommonlyUsed DialysisDisinfectants

• PeraceticAcid(PAA)

• Glutaraldehyde

• Chlorineand/orChloramine• • Citricacid



PeraceticAcid(PAA)Disinfectants

• Stabilized mixture of hydrogen

peroxide and peracetic acid

3



ses or s n ec an s se PeraceticAcid

Concentration Time(minimum) emp

Dialyzer reuse 3.25% 11 hours < 21°C

Dialysis Machine

Disinfection0.5% 30 minutes

Water Distribution

Lines. m nutes

Bicarb Mixing &2% 2 hours 25°C

RO machines 0.75% - 1% 30 minutes < 25°C

*Always refer to the manufacturer's instructions for disinfectant concentration, temperature

and dwell times as these parameters may change from one manufacturer to another



Chemical

%

Hydrogen Peroxide

Ratio of

Hydrogen Peroxide

Actril® 0.8% Hydrogen Peroxide

0.06% Peracetic Acid13.3:1

Renalin®20% Hydrogen Peroxide

4% Peracetic Acid5:1

Minncare® 22% Hydrogen Peroxide4.5% Peracetic Acid

4.8:1

Peracidin™

4.5% Peracetic Acid6:1



•

~37% by weight formaldehyde gas in~

prevent polymerization • CH2O



Use

Glutaraldehyde Timem n mum

Tem

Dial zer 0.8% 15 min 20°C

Dialysis

Machines. °

* ' ,

and dwell times as these parameters may change from one manufacturer to another.



•

5.25%sodiumhypochlorite • Amuchina

– A cav s100 or a ys smac nes equ pment – ARMCleanfordialyzerreuse

• 500ppmuse‐dilution



Use

or ne

ConcentrationTime Temp

Water Treatment

System°

Water Distribution

Lines 500 ppm 2 hours 25°C

Dialysate Mixing &

Delivery System500 ppm 2 hours 25°C

Dialysis MachineDisinfection 500-750 ppm 30-40 mins 25°C

* ' ,




Foradequatedisinfectionof watertreatment

systemstheNANTDialysisTechnologymanualrecommends

• 1ppmozonefor10minutes• 0.5

‐ppmozonefor20minutes



• , effective

for

reducing

both

bacteria

and

endotoxinconcentrations.



Use Concentration Time Temp

Dialyzer reuse 1.5% 21 hrs 95°C

Dial sis Machine 10% - 50% 95°C

*Always refer to the manufacturer's instructions for disinfectant concentration, temperature




DisinfectantStandards for

Hemodialysis



1.

AAMI

‐

Associationfor

the

Advancement

of MedicalInstrumentation

Allianceof healthcareprofessionals,

officialsdedicatedtotheunderstanding technology.



2. DialysisIndustry T eco ectiveexpertiseo ea t care

professionals,industry

representatives,

medicaldevicemanufacturersandgovernmentofficials



AAMIStandards&Guidelines• Standards ‐ informationsuppliedbythemedical

devicemanufacturertoensuresafe&effectiveusein

• Guidelines ‐ procedures&practicestohelpensure performanceismaintained



Disinfectant Potency Residual

Peracetic Acid 1% –3.5% <3 ppm

4%

0.8% - 1.0%

Glutaraldehyde 0.8% <2 ppm

Bleach (NaOH) 0.25% - 0.50% <0.5 ppm

Free Chlorine Not Applicable <0.5 ppm

Chloramine Not Applicable <0.1 ppmOzone PMI* PMI*

Citric Acid & Heat 1.5% - ?? %



Formatof DisinfectantTests

• Powderedcolorimetrictests

• Dry‐reagentteststripsorpapers



Formatof DisinfectantTests • observingforthedevelopmentof color• comparingthereactedtesttoacolorstandardSomeliquidtestscanalsobereadelectronically

usingameter



resultindeteriorationof thetest’s

.Poortreatment=Poorperformance



• ‐ fitforitsintendedusewhenstoredperitslabeling

• UseLife‐ theperiodof timetheteststripswillstillperformtospecificationsafteropeningandclosing

Test abuse



Testabuse .

2. Notstoringproductinrefrigerator

Selecting the Right



SelectingtheRight DisinfectantTest

Youhavetoknow: • whatisthetargetconcentrationof the

• whatsensitivityandspecificitydoyou• isthetestspecificallydeveloped,labeled



• • Specificity • PotencyorResi ua • Quantitative,

Semi

‐

quantitative,Qualitative



,comparedtothealternative.However………Simpletouse don'tfollowinstructions



Technique• Followthe“DirectionsforUse”closely



•

accuracy factorthatmayaffecttestresults.

• Yourco orpercept oncana soa ectinterpretationof testresults.



• • Readinsert• Instructions oruse



InappropriateTests

• Starchpaper• HemaStixUrineStrips• CliniTestUrineTablets

1 environmental complications

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