Promoting and facilitating high quality care standards for dialysis and kidney transplant patients
in Iowa, Kansas, Missouri and Nebraska.

Main phone (816) 880-9990
Patient toll free (800) 444-9965
Main fax (816) 880-9088
Data fax (816) 880-1775

7505 NW Tiffany Springs Pky. Suite 230 Kansas City, MO 64153

Hot Topics and Heads Up

Fall 2006 - Hemolysis:101

What is hemolysis?

It is the rupture or lysis of red blood cells. Hemolysis is a potentially life threatening condition which may affect multiple patients!

What would you see?

Diluted looking blood in the dialysis tubing – kind of like cherry Kool-Aid® rather than thick maroon normal looking blood.

What are the patient’s symptoms?

Chest pain, dyspnea, abdominal pain, hypotension, burning pain, complaint of “feeling “hot”. Abdominal pain may be the first symptom and could be delayed for hours.

What can cause hemolysis?

Several things can cause hemolysis including excessive heat, chemical exposure, hypertonic or hypotonic solutions, kinked tubing, inadequate water treatment, and mechanical pressure.

What is the treatment for the patient?

Discontinue dialysis. Do not reinfuse the hemolyzed blood to the patient. Contact the physician immediately. Monitor vital signs. Place the patient on the cardiac monitor and check for arrhythmias. Observe for hypotension and shortness of breath. Check hematocrit, hemoglobin, and electrolytes. The potassium may spike. Administer oxygen at 2-4 L/nc. Replace volume and give blood transfusion if ordered. Hospitalization may be necessary. (Note: Keep the patient’s tubing and dialyzer. Sample the water coming into the machine. Isolate the machine, dialysate, and any other items. You will need to examine these things during your internal investigation.)

No diaylsis treatments should be given at the facility until the cause of hemolysis has been determined and/or a thorough investigation has been conducted!

How should we investigate a suspected hemolysis event?

First of all, assume it is hemolysis until you can rule it out. Contact the Network - other dialysis facilities may be having problems also. The Network can offer guidance for troubleshooting. In 1999, defective dialysis tubing caused a deadly outbreak of hemolysis affecting patients in at least two states.

Look internally at the following things:

• Water treatment
• Machine maintenance
• Reuse records
• Residual chemical testing
• Water/dialysate bacteriology
• Dialysate and bicarbonate mixing
• Disinfection of the loop
• Review policies and procedures
• Conductivity meters & testing

Still stuck? Get outside help! (Examples)

Corporate experts, dialysis water experts, Heartland Kidney Network, State Agency, Health Department, Local water department, Centers for Disease Control and Prevention, Hospital officials.

Sources: Core Curriculum for Nephrology Nurses, Heartland Kidney Network suggestions, State Agency suggestions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

© 2008 End-Stage Renal Disease (ESRD) #12 Network Coordinating Council, Inc. dba Heartland Kidney Network
This resource was (created, developed, compiled, etc.) while under contract with Center for Medicare and Medicaid Services, Baltimore, Maryland. Contract #HHSM-500-2006-NW012C. The contents presented do not necessarily reflect CMS policy.