Hemolysis
Etiology1
- Mechanical
- High blood pump flow
- Single-needle dialysis
- Small gauge cannula
- Kinked blood lines
- High negative arterial pressure
- Offset blood pump
- Failure of rinsing
- Hydrogen peroxide
- Contamination with
- Hypochlorite
- Formaldehyde
- Priming error
- Hypotonic saline
- Dialysate error
- Hyper or hypotonic dialysate
- Overheated dialysate
- Dialysate contamination
- Chloramines
- Nitrates
- Copper
Treatment
- Stop blood pump, clamp venous bloodline and discard the blood
- Provide oxygen to the patient
- Type and cross of blood transfusion if needed
- Resume HD as soon as patient is stabilized, since hyperkalemia accompanies hemolysis
Prevention
- Test machine prior to use to ensure that the air detector alarm system is working effectively
- Avoid chemical contaminants that can damage RBC’s
- Oxidants such as chloramines, copper, zinc
- Reducing agents such as formaldehyde, hypo or hypertonic dialysate
- Overheated dialysate
- Avoid small needles
- Highly negative arterial pressure alarms
- Ensure correct positioning of tubing in the roller pumps
- Avoid accidental compression of lines
Reference:
1. Davenport A: Intradialytic complications during hemodialysis. Hemodial Int 10:162-167, 2006