A – Hypotension
Is found in 20 to 30% of the sessions.
There are several etiologies: An excessive decrease in the volume, inadequate peripheral vasoconstriction (diabetic patients for example), or cardiac function improperly or failed.
Clinical: Sudden fall in blood pressure, feeling sick (hot flashes, discomfort, tachycardia, possibly loss of consciousness). Yawning is often a precursor met.
What to do:

  • Reducing the speed of the pump blood ..
  • Last sloping patient.
  • Intake of saline (on prescription)
  • Eventually, put under O2 (depends on service protocols)

Prevention:

  • Never ultrafilter patients below its base weight.
  • Weight gain rigorous
  • Avoid taking anti-hypertensive before the dialysis session
  • Rate of Na in the dialysis at a concentration equal to or lower than the patient. (Reminder: the Na profile is a prescription)

B – angina
Aggravating factors: anemia, decrease in BP, in hyper-debit FAV
What to do:

  • Preventing nephrologist
  • UF minimum
  • Decreased blood flow
  • O2 nasal + scope
  • possibly following protocols, use nitroglycerin sub-lingual.
  • If the crisis continues, stopping hemodialysis, restitution, perform ECGs, biology (KPC / CPKMB / LDH etc. ….), transfer in a specialized



C – PAO
A etiology:

  • Hypervolemia
  • Acute heart failure or chronic
  • Anemia
  • Uncontrolled hypertension
  • Drug causes (B-Blockers)
  • Pump failure causing UF retro-filtration dialysis

Clinic:

  • Dyspnea
  • Cyanosis
  • Anxiety
  • Chest pain
  • Cough more or less expectoration of pink frothy fluid
  • Distended jugular consequences of hypervolemia and / or heart failure

What to do:

  • Emergency ultra-filtration (UF isolated, it is possible to mount 2L / H on prescription in this case, it should mount a dialyzes steep)
  • Oxygen nasal min 3L/min
  • ECG, scope

D – Muscle cramps:
Aetiology:

  • Dehydration extracellular
  • Dry weight estimated too low
  • UF excessive
  • Na, Ca, Mg too low concentration in the dialysis

What to do:

  • Stop ultra-filtration
  • Prescription, Hypertonic NaCl addition and / or saline
  • Rub with ice



Prevention:
On prescription, increased concentration of Na, dialysis or concentration of variable Na

E – Acute Hemolysis
Aetiology:

  • Dialysate hypo / hypertonic
  • T ° inappropriate
  • On the CEC, closed for over a quarter of an hour, kinking, pump blood occlusive

Clinic:

  • Anxiety, sweating, malaise + + +, brutal
  • Back pain sudden and very intense;
  • Abdominal cramps
  • Tightness, dyspnea
  • Presence in the circuit, blood taking an aspect of currant jelly

What to do:

  • Stop UF, NOT TO REPAY
  • Disconnect
  • Symptomatic treatment
  • Sampling of water, dialysate, the patient’s blood to determine the cause

F – Air embolism
Aetiology:

  • Entry of air into the CEC
  • Disconnection unsecured (withdrawal of air detector)
  • Debulage, air intake on the venous tubing

Clinic:

  • Polypnea
  • Cyanosis
  • asphyxia
  • arrhythmias

What to do:

  • Immediate cessation of UF
  • Clamp the arterial and venous lines
  • Patient sloping + + +
  • Aspirate if the patient has a central lane (vacuum bubbles located right in the heart)
  • Oxygen

Preventing medical and rescue support for immediate hyperbolic chamber

G – Coagulation:
Aetiology:

  • No heparinization,
  • failure of the pump causing an increase in PV and PTM, and a bleeding mass of the entire circuit
  • Case circuit over 15 minutes

What to do:
Do not return, make a new connection circuit.

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