Hemo Hemlper wrote:“We have not had any problem with not returning all the blood yet… except for once when I forgot to press stop before I closed the clamps on the red line before attaching it to the priming spike for rinse back… Got air in the system and ended up not being able to return all the blood Because the air eventually was sensed by the air sensor in the Venus (blue clamp) line. This will make it impossible to get the machine to do any more rinse back… SAFTEY built into the machine to make sure you do not get air in the patient’s veins…Known as AIR EMBOLISM…”
We had a situation something like this where the machine locked up on us just prior to rinseback. I think we had gotten an alarm at the last second which we cleared and mistakenly thought the tx was over when we hit prime. But the tx had a few more seconds to go ( was not finished showing 000’s and dinging) so it locked up. This may be a totally different situation then what happened to you. We did a manual return that day with no problems. But had my machine lock up been due to air, I would of been in big trouble!
We were not given any training about air embolism other than to watch for air in the venous line at put on and return and clamp if air pocket is traveling towards me. Can someone explain what one should know about AIR EMBOLISM with NxStage txs…how to differentiate when air is the problem and take safety precautions? What are the specific instances one must be aware of air and what are the procedures to deal with it?
Air embolism is when you do get air or suspect that when returning the blood to the patient air is sent back in to the patients. IF YOU SEE AIR IN THE ARTERIAL OR VENOUS CATHATER LIMBS OR FISTULA NEEDLES OR BLOODLINES:
Clamp cathater limbs or fistula needles immediately if embolism is suspected.
IMMEDIATELY lie down on LEFT side with heads below heart.
Call 911
Remain in this position until rescue workers arrive…
From my training manual Usen on Fresenus Machine
WHAT YOU NEED TO DO:
IMMEDIATELY clamp cathater limbs,or fistula needles. Stop blood pump
TURN PATIENT ON LEFT SIDE IN A FLAT POSITION, KEEPING HEAD DOWN AND FEET UP.
This will trap air in the right side of the heart and keep the air from going to the brain.
Check patient’s Vital signs…(blood pressure, Pulse, Temp, etc)
Call: 911
Be ready to start CPR.
Causes:
Loose connections between the cathater and bloodlines.
loose connections between the fistula needles and bloodlines.
Malfunction of the air detector.
Crack in the cathater.
Crack in the fistula.
Faulty tubing.
Distraction during take-off and allowing air to enter the tubing.
Air was not completely expelled during set-up.
VENOUS TUBING IS NOT IN VENOUS CLAMP. (Fresenius machine)
Signs and symptoms of an air embolism to the brain.
Coughing
pain,tightness or tingling in chest.
Shortness of breath.
Roaring in ears.
Dizziness
Confusion
Impaired speach.
Double Vision.
Seizures. Death may occur rapidly
Sounds scary but Just keep your cool and follow the directions…
I am concerned that they did not review things like this before sending you home…
Here’s a list of Things that we covered in our training (Fresenius machine)… Hope you can get your training nurse to go over these and get you information as to what you need to do if this happens when you are at home besides calling 911 and their 24 hour help line… and what could possibly be the cause so you can review your procedure and see if you caused this condition when you talk to the rescue workers.
ARRTHYTHMIAS (Irregular pulse)
CARDIAC/RESPIRATORY ARREST
HYPERTENSION (High blood Pressure)
HYPOTESNION (Low Blood Pressure)
HYPOTENSION SEIZURE
ANGINA
MUSCLE CRAMPS
NAUSEA & VOMITING
PYROGENIC SHOCK
HEMOLYSIS (breakdown of red blood cells)
CRENATION (Shrinking of red blood cells)
HEMATOMA (for patient with fistula or graft)
These should have been at least mentioned in your training as these problems can happen… Only one that happened to us is Muscle cramps…
Yes, it is scary knowing that you could have any of these problems at home. While going to the dialysis center to have your blood cleaned, I know they have seen some of these problems there. But if you keep your cool and concentrate on what you are doing you will prbably never have any of these problems.
THANK YOU for answering my post Hemo Helper! None of this was covered in our training!! We were trained super fast and sent out the door. We were glad to go home, but we did not get a thorough training as some patients say they got. I wondered what we needed to know as far as emergency training. Once when I was in-center I got some air bubbles and it was beyond scary. I did have a good nurse with me, but even she could not find the source of the air. The air alarm never went off ( I see this is covered on your list). I was never put in the appropriate position on left side. I guess she did not think I was in that much distress, but I was. Fortunately, I recovered in about 45 min, but it was really scary.
What is a crack in a fistula (do you mean graft)? And how would air enter the tubing at take off? Does this apply to NxStage, too? I’ve heard of this, but don’t know how it happens.
Is put on or take off the only times one would see an air pocket in the lines? When I got air, I had been on the tx for a short time. This was a long time ago. I didn’t know how to look for any signs of air back then. Could air appear in the lines at any time of the tx? If that is the case, wouldn’t it be a risk to be asleep? You are the only person I know who has spoken about emergency training. I hope everybody got such training and knows what to do if faced with air.
[QUOTE=Unregistered;12351]THANK YOU for answering my post Hemo Helper! None of this was covered in our training!! We were trained super fast and sent out the door. We were glad to go home, but we did not get a thorough training as some patients say they got. I wondered what we needed to know as far as emergency training. Once when I was in-center I got some air bubbles and it was beyond scary. I did have a good nurse with me, but even she could not find the source of the air. The air alarm never went off ( I see this is covered on your list). I was never put in the appropriate position on left side. I guess she did not think I was in that much distress, but I was. Fortunately, I recovered in about 45 min, but it was really scary.
What is a crack in a fistula (do you mean graft)? And how would air enter the tubing at take off? Does this apply to NxStage, too? I’ve heard of this, but don’t know how it happens.
Is put on or take off the only times one would see an air pocket in the lines? When I got air, I had been on the tx for a short time. This was a long time ago. I didn’t know how to look for any signs of air back then. Could air appear in the lines at any time of the tx? If that is the case, wouldn’t it be a risk to be asleep? You are the only person I know who has spoken about emergency training. I hope everybody got such training and knows what to do if faced with air.[/QUOTE]
Hi;
Do not know what a crack in a fistula is… My partner has always had and still uses a cathater… Air can enter the system because of poor set-up… had it happen while using the Fresenius. Can’t remenber why but the air detector would not let me return the blood. The nxStage is also has a air detector in the venus line so if it detects any air it will not let you return the blood. I had this happen… I closed the (red) clamps before pressing stop… think it was for a few seconds and air entered the line when I disconnected the aterial line from the patient and hooked it up the the red line on the priming spike and started to return the blood… it went all right until the air was sensed in the venus line. Then it would not let me return anymore blood. Ended up with an upset partner that lost about 40 cc’s of blood.
Maybe you need to go back to your trainer and see if they have any training for the topics that I mentioned… You will probably not have any of those problems but it is good to have information about them… yet I know about Air embolism I can’t remember how much air would cause problems… So If I see any air (not tiny bubbles) in the parient blood lines I know to call 911, Patient on left side, head lower than feet. And let them take care of it.
Do not know what a crack in a fistula is… My partner has always had and still uses a cathater… Air can enter the system because of poor set-up… had it happen while using the Fresenius. Can’t remenber why but the air detector would not let me return the blood. The nxStage is also has a air detector in the venus line so if it detects any air it will not let you return the blood. I had this happen… I closed the (red) clamps before pressing stop… think it was for a few seconds and air entered the line when I disconnected the aterial line from the patient and hooked it up the the red line on the priming spike and started to return the blood… it went all right until the air was sensed in the venus line. Then it would not let me return anymore blood. Ended up with an upset partner that lost about 40 cc’s of blood.
Maybe you need to go back to your trainer and see if they have any training for the topics that I mentioned… You will probably not have any of those problems but it is good to have information about them… yet I know about Air embolism I can’t remember how much air would cause problems… So If I see any air (not tiny bubbles) in the parient blood lines I know to call 911, Patient on left side, head lower than feet. And let them take care of it.
HemoHelper[/QUOTE]
One tx. we had air enter the line (think it was the art.) as the patient line was not screwed on to the needle line correctly, didn’t thread right. We knew there was air because we clearly saw a lot of it traveling in the line. We clamped and lost the blood and started the tx over.
IN the situation you described with air getting in through the art. when you connected to the priming spike, did you see any air in the line or did you just know there was air in the venous line because the machine would not let you return the blood?
Do you mean you would call 911 if you just see air or only if patient is getting symptoms? Your comments have given me a good starting point. I will definitely ask my nurse and NxStage for better guidelines who how to prevent air from getting in the system and how to know if it does.
You can learn about air embolisms, and a lot of other useful stuff in the new Core Curriculum for the Dialysis Technician, which you can download from the Medical Education Institute website (http://www.meiresearch.org. This resource was developed to help train in-center techs, but there’s a lot of other good information in it.
[QUOTE=Unregistered;12435]One tx. we had air enter the line (think it was the art.) as the patient line was not screwed on to the needle line correctly, didn’t thread right. We knew there was air because we clearly saw a lot of it traveling in the line. We clamped and lost the blood and started the tx over.
IN the situation you described with air getting in through the art. when you connected to the priming spike, did you see any air in the line or did you just know there was air in the venous line because the machine would not let you return the blood?
Do you mean you would call 911 if you just see air or only if patient is getting symptoms? Your comments have given me a good starting point. I will definitely ask my nurse and NxStage for better guidelines who how to prevent air from getting in the system and how to know if it does.[/QUOTE]
Yes, When you clamp the line and leave the pump running for a few seconds when you open the line it will suck in air… Maybe I had only clamped one of the red clamp but I remember seeing the tubing full of air… about 12 to 14 inches of it was full of air.
Yes, I would call 911 because I would not know how much air I had given the patient. It is better to be safe than sorry. I do not know how long it would be before you see any symptoms. If you know that you have given air back to the patient I feel that it would be in my best interest to get professional help ASAP.