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Hemodialysis Complications
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Muscle Cramps
Often due to hypovolemia, hyponatremia, or hypocalcemia. Prevention includes careful regulation of electrolytes and avoiding high ultrafiltration rates. Management includes stretching, warm compresses, and proper electrolyte replacement.
Hemolysis
Can be caused by mechanical damage or high chlorine levels in dialysate. Prevention includes regular maintenance of dialysis equipment and proper dialysate preparation. Management involves stopping treatment and supportive care.
Anaphylactoid Reactions
Caused by reaction to dialyzer membrane or sterilants, manifested by symptoms like itching or hypotension. Prevention includes using biocompatible membrane and proper rinsing of the dialyzer. Management involves stopping dialysis and symptomatic treatment.
Cardiac Arrhythmias
Electrolyte imbalances or coronary artery disease can lead to arrhythmias during dialysis. Prevention by careful monitoring and correction of electrolytes, and assessing cardiac risk factors. Management may involve ECG monitoring and appropriate medications.
Hypotension
Occurs due to rapid removal of volume leading to decreased cardiac output. Prevention includes proper fluid management prior to dialysis and gradual ultrafiltration. Management may include interrupting dialysis, leg elevation, and saline administration.
Access site infection
Can occur from bacterial contamination. Prevention involves strict aseptic technique and proper hand hygiene. Management includes antibiotics and potential removal of access if severe.
Hypoxemia
May occur from decreased oxygen carrying capacity due to blood loss or high ultrafiltration rates. Prevention includes monitoring oxygen saturation and careful fluid removal. Management may require supplemental oxygen or adjustment of ultrafiltration rate.
Disequilibrium Syndrome
Results from rapid changes in blood composition causing cerebral edema. Prevention by slow dialysis rate initially, especially in patients new to dialysis. Management includes reducing dialysis efficiency and supportive therapy.
Air Embolism
Occurs when air enters the blood through the vascular access. Prevention by ensuring all air is purged from the system before starting and avoiding disconnections. Management includes positioning the patient on the left side and in Trendelenburg, administering oxygen, and supportive measures.
Vascular Steal Syndrome
Ischemia of the hand caused by arterial insufficiency due to the vascular access for dialysis. Prevention by careful pre-operative vascular assessment. Management includes surgical revision of the access or sometimes access closure.
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