Regional Operations Director, DaVita Dialysis, Boise, ID.
Risk Manager, DaVita Inc., Denver, CO.
Nephrol Nurs J. 2021 May-Jun;48(3):237-240.
Hemolysis may be an infrequent cause of hemodialysis blood leak alarms. We report the case of an unresponsive adult male who was placed on hemodialysis with a high-flux dialyzer. Within five minutes, the blood leak alarm sounded. The care team discontinued treatment and made two additional attempts to reinitiate hemodialysis with different machines, blood tubing lots, and brands of high-flux dialyzers, but continued to receive blood leak alarms. Laboratory studies were consistent with severe hemolysis. The attending nephrologist subsequently ordered continuous veno-venous hemofiltration, which was initiated and continued into the following day without incident or alarm. The patient later expired from complications of near-drowning. In the event of significant hemolysis, continuous kidney replacement therapy or hemodialysis with a low-flux dialyzer, and a lower ultrafiltration rate may be indicated.
溶血可能是血液透析血液渗漏报警的一个不常见原因。我们报告了一例无反应性成年男性，该患者使用高通量透析器进行血液透析。在 5 分钟内，血液渗漏报警响起。护理团队停止治疗，并使用两台不同的机器、两批不同的血液管路和不同品牌的高通量透析器重新尝试开始血液透析，但仍持续收到血液渗漏报警。实验室研究结果与严重溶血一致。主治肾病医生随后下令开始连续性静脉-静脉血液滤过，无任何意外或报警，持续进行至次日。该患者后来因溺水并发症而死亡。在发生严重溶血的情况下，可能需要使用连续肾脏替代疗法或低通量透析器进行血液透析，以及较低的超滤率。
