Blood Loss, Infiltration, Clotting, Air, Hemolysis, and Fever
Key Takeaways
- Blood loss and access infiltration require immediate attention to patient safety and access protection.
- Clotting signs include pressure changes, darkening blood, streaking, and impaired circuit flow.
- Air, hemolysis, fever, chills, or suspected contamination are high-risk events that require urgent escalation.
- Do not return blood to the patient if safety is uncertain or facility policy prohibits it for the event.
High-Risk Complications
Blood outside the circuit, air in the bloodline, hemolysis, clotting, and fever or chills are not routine alarms. These findings can become emergencies quickly. The technician's role is to recognize danger, keep the access and circuit secure, follow policy, notify the RN or qualified staff, and document the event.
Access and Circuit Red Flags
| Event | Clues | Priority Action |
|---|---|---|
| Blood loss | Wet clothing, leaking connection, dislodged needle, blood on chair | Stop blood loss, protect access, call for help. |
| Infiltration | Swelling, pain, firmness, poor flow near needle | Stop using affected needle per protocol and notify RN. |
| Clotting | Rising pressures, dark blood, streaked dialyzer, clots in chamber | Assess circuit, report, do not ignore trend. |
Emergency Red Flags
| Event | Clues | Priority Action |
|---|---|---|
| Air in line | Air detector alarm, visible air, loose connection | Clamp as required by machine safety, call RN, follow protocol. |
| Hemolysis | Cherry or port-wine blood, pain, shortness of breath, heat or chemical concern | Stop treatment per policy, do not return blood unless directed, escalate. |
| Fever/chills | Rigors, temperature rise, malaise | Notify RN, assess vitals, follow infection and culture policy. |
Hemolysis is especially high risk because damaged red blood cells can release potassium and cause severe patient harm. Possible causes include dialysate problems, temperature issues, chemical contamination, kinked bloodlines, or mechanical damage. Treat suspected hemolysis as an emergency.
For suspected air embolism, the exam-safe response is immediate escalation and facility emergency procedure. Do not bypass alarms or silence them without correcting the cause. Any equipment or setup concern should be reported and documented as an adverse event according to facility policy.
During dialysis, the technician sees blood soaking the patient's sleeve near the access arm. What is the priority?
Which finding is most concerning for possible hemolysis?
A venous pressure has been rising for 20 minutes, the venous chamber looks darker, and small clots are visible. What should the technician suspect?