Complications & Management of Hemodialysis:

1)Muscle cramps – Due to excessive fluid removal related to dialysate Na concentration associated with
hypocalcemia or hypokalemia.

S/S : Painful muscle spasms

Tx: Stop ultrafiltration, Bolus with dose osmotic agent (D50, Mannitol, 100cc NS)

Extend cramped muscle by pressing againsts the muscle with your hands or legs.

2)Chest pain – Due to anemia, cardiac disease, coronary artery spasms, severe vascular volume
depletion

Txs: Discontinue of dialysis of severe administration O2 of drugs as ordered, decrease UF rate, Assess &
treat volume depletion.

3)Hypotension – excessive or inaccurate volume depletion, consumption of large meals on dialysis,

anemia, and hypertensive meds., Unstable cardiac status, hypoalbuminemia, incorrect UF rate.

S/S: Anxious feelings, Nausea & vomiting, Dizziness or faint feeling, Pallor, Yawning, Hot feeling,
Sweating, Tachycardia, LOC.

Txs: Decrease or discontinue UF, place in trendelenburg position, Infuse 100-200cc of NSS, D50, Albumin
or hypertense saline. Chech B.P. every 5 mins. & notify doctor.

4)Nausea & Vomiting – Due to hypotension disequil, too rapid UF, Meds, Allergy, Flu.

Txs: Stop UF, Infuse 100 cc of NSS, Check B.P.

5)Headache – Due to disequil, hypertension, anxiety

Txs: Stop UF for 5 mins, Pain reliever

6)Disinfectant reaction – Inadequate rinsing of a dialyzer, disinfectant present in the H 2O system.

S/S: Paint at the site, Chest & back pain, S.O.B., Irregular pulse, dry mouth, thick tongue

Txs: Stop UF, Infuse 100cc NSS, Check B.P., Check V/S, Recirculate the blood for 15 mins, Check blood
lines for brownish color, if present discard the blood.

7)Dysrhytmias- electrolytes and PH changes, underlying heart disease, removal of antiarrhytmic drugs
during dialysis.

Txs: Anti - arrythmia drugs as prescribed, Discontinue if severe, Monitor with EKG if possible

8)First use or allergic dialyzer reaction – complement activation pathway by new cellulosic membrane,
reduce with reuse cellulosic membrane.
S/S: Back pain, chest pain, hypotension

Txs: Use of synthetic membrane, reuse of cellulosic membranes with agents which removes the protein
coat on the membrane.

9)Hypoglycemia – Decrease in blood sugar

S/S: B.P. may or 20-30mmHg, H.R. may or , Sweating, Cold clammy skin, Slurred speech,
Tremor progress – convulsion, Headache, Nervousness, Restlessness, Irritability

Txs: Check Bld. sugar, Administer sugar by mouth or IV depending on doctor’s order.

10)Hyperglycemia – Increase in blood sugar, too much insulin or eating too many carbs.

S/S: H.R. is rapid, Deep respiration, Thirst, Hot, Dry flushed skin, Vomiting, Abdominal pain, Drowsiness,
Flushed face

Txs: Check Bld. sugar, Notify the doctor

11)Seizures – Hypotension, reaction to chemical agent, electrolyte imbalance, dialysis disequil, dialysate
composition errors

S/S: Change in LOC, Jerking movement of arms and legs

Txs:Maintain airway, Stop UF, Turn down blood, Infuse Saline, Notify doctor

12)Hemolysis- Due to hypertonic or hypotonic saline, over heated dialysate, blood pump is not
calibrated properly, chloramine in the H2O supply, disinfectant in the dialyzer

S/S: Chest pain, Dyspnea, Hypotension

Txs: Discontinue dialysis, Do not reinfuse hemolyzed blood, Monitor V/S, Notify the doctor, O 2
administration, Clear blood in the venous blood line (Transluscent), Localized burning pain in circulatory
access return to site, If hypertensive dialysate, disrythmias acute decrease in hct., Hyperkalemia

13)Cardiac Tamponade – Due to acute hemorrhagic pericarditis, Chronic pericarditis, Constrictive

pericarditis.

S/S: Central chest pain worse when supine, improves when upright pericardial friction rub

Fever, Hypotension, Distended neck vein, Muffled heart sound, Absent apical pulse.

Txs: Discontinue hemodialysis if severe, Minimal or no anti-coagulant, Surgical intervention may be

required
14)Anaphylactic Reaction – Maybe hypersensitive to ETO used to sterile the dialyzer, most likely with
cuprophane membranes.

S/S: Acute bronchoconstriction, Initial feeling of uneasiness followed by agitation, S.O.B., coughing,
wheezing urticurtia, faced edema, flushing, respiratory arrest, vasodilation & hypotension or
hypertension.

Txs: Use of another dialyzer

15)Air Embolism – Defective air detector

S/S: Visualization of air in the system, Chest pain, Dyspnea, Coughing, Cyanosis, Visual problem,
Confusion, Coma, Hemiparesis, Death

Txs: Discontinue Hemodialysis, Turn to the Left side or trap the air in the apex of Right ventricle, O2 (4-
6L/min), Check V/S, Notify & carry out order.

16)Cardiac Arrest & Respiratory Arrest – Due to electrolyte imbalance, Dysrhytmias, M.I., Cardiac
Tamponade, Large air embolism, hemolysis, hyperthermia, etc.

S/S: (–) apical & carotid pulse, Lack of spont., Unresponsive, Abnormal heart beat or cardiac monitor

Txs: Assess for signs & symptoms & call for assistance, Trendelenburg position, Attempt to arouse the
patient with verbal stimuli, Administer O2, Return blood, Get the emergency cart, Suction, Call –
ambulance, Give meds as ordered, Assists with respi with ventilator bag & commence CPR if cardiac
arrest occurs, Transfer to hospital.

17)Fever & Chills

-reduce Temp. momentarily, Adminiter anti – histamine (Hydrocortisone), Discontinue if severe, Notify

18)Disequilibrium Syndrome – Drastic change in ECF fluid.

S/S: Headache, Nausea & Vomiting, Tremors, Seizure

Txs: BFR, Hypertonic saline if cramps persist, Gentle Hemodialysis for 1 st 1 – 2 hours.

19)Hematoma – Hemodialysis, STOP if severe

- Surgical drainage if a threat to the AV fistula

-Avoid hemodialysis at least 24hrs. post operative.