Malinauskas Richard A
U.S. Food & Drug Administration, Center for Devices and Radiological Health, Silver Spring, Maryland, USA.
Hemodial Int. 2008 Jul;12(3):383-93. doi: 10.1111/j.1542-4758.2008.00285.x.
The source of hemolysis during hemodialysis must be quickly identified to avoid life-threatening complications. At a single clinic, over a 10-day period in which 550 treatments were performed, 5 case-patients were retrospectively identified for experiencing acute hemolysis (4 deaths) from an unknown origin. The investigation focused on the postpump arterial tubing as the pressure was not monitored in this region, and the segment was shorter than required and could kink if overly stressed at bend points (i.e., tubing support clips, dialyzer inlet). To determine whether the circuit pressures indicated kinked tubing, a relative comparison between each case-patient's recorded arterial (prepump) and venous circuit pressures throughout their adverse event treatment and their immediately preceding treatment was conducted. Treatment pressure-time traces showed that sustained, significant decreases (>25 mmHg) in both of the circuit pressures occurred only on the hemolytic event dates. While direct observations of kinked tubing were not reported, the circuit pressure decreases could only be explained by severe postpump tube kinking causing a decrease in the blood flow rate. While postpump obstructions and hemolysis can occur without causing noticeable changes to the prepump arterial and venous blood line pressures (due to the highly occlusive setting of the roller blood pump), recognizing sudden and/or sustained decreases in the circuit pressures during treatment may help to prevent adverse patient events. This analysis reinforces the importance of regularly checking the blood tubing set for kinks and for monitoring the circuit pressures for atypical trends within and between treatments.
必须迅速确定血液透析期间溶血的来源，以避免危及生命的并发症。在一家诊所，在为期10天的时间里进行了550次治疗，回顾性确定了5例患者因不明原因发生急性溶血（4例死亡）。调查重点是泵后动脉管路，因为该区域未监测压力，且该段管路比要求的短，如果在弯曲点（即管路支撑夹、透析器入口）过度受力可能会扭结。为了确定回路压力是否表明管路扭结，对每位病例患者在不良事件治疗期间及其紧接的前一次治疗期间记录的动脉（泵前）和静脉回路压力进行了相对比较。治疗压力-时间曲线显示，仅在溶血事件发生日期，两个回路压力均出现持续且显著的下降（>25 mmHg）。虽然未报告直接观察到管路扭结的情况，但回路压力下降只能解释为泵后管路严重扭结导致血流速率降低。虽然泵后阻塞和溶血可能发生而不会导致泵前动脉和静脉血路压力出现明显变化（由于滚压式血泵的高度闭塞设置），但识别治疗期间回路压力的突然和/或持续下降可能有助于预防不良患者事件。该分析强化了定期检查血路管是否扭结以及监测治疗期间和治疗之间回路压力的非典型趋势的重要性。
