Dialyzer Membrane Rupture During Hemodialysis Treatment

The observation of patients during hemodialysis treatment is closely related to the principle of hemodialysis treatment.

Hemodialysis is a process of using a semipermeable membrane made of special materials to make hollow fibers. Blood runs in the hollow fiber lumen, and dialysate runs outside the hollow fiber tube. The blood and dialysate are separated by the dialysis membrane. During the flow of blood and dialysate, dialysis treatment is performed through diffusion, convection, and other principles.

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In this process, in addition to observing and caring for dialysis patients, it is also necessary to focus on the safety of dialysis equipment, formulate various emergency plans for possible adverse events, and deal with emergencies in a timely manner. Among them, certain reasons in hemodialysis treatment cause the hollow fiber membrane of the dialyzer to rupture, and the blood in the lumen enters the dialysate and leaks, resulting in adverse events of dialyzer membrane rupture and bleeding.

Although dialyzer membrane rupture events are rare, there are still a certain number of cases in multi-center exchanges and learning. In order to prevent them before they happen, we will discuss and learn with more colleagues and formulate emergency plans.

Analysis of possible causes of dialyzer membrane rupture

In the early years, dialyzers were reused. During the reuse process, due to improper operation, excessive pressure during flushing, and excessive disinfectant concentration, the dialyzer may be damaged.

However, in recent years, there has been basically no reuse of dialyzers. During the use of disposable dialyzers, the dialyzer coagulation is caused by improper use of anticoagulants during treatment, and the dialyzer membrane rupture is caused by high pressure; the ultrafiltration volume is too large in a short period of time, or the transmembrane pressure exceeds the filter pressure due to some factors in the dialyzer, which can cause the dialyzer membrane to rupture.

At the same time, the dialyzer is damaged and the quality is not up to standard during transportation or process manufacturing, and membrane rupture and bleeding are discovered during use; in addition, during the pre-flushing process or treatment process, the replacement fluid tube is improperly used when the HDF mode is selected, the pressure detection is not timely, and the relevant alarms are not handled in time, which can also cause the dialyzer membrane to rupture.

Clinical manifestations of dialyzer membrane rupture during hemodialysis treatment

When the dialyzer membrane ruptures, blood can be seen entering the dialysate chamber from the hollow fiber membrane blood chamber, and the dialysate turns red. The rapid development process will see a large amount of blood in the bypass tube. At this time, the dialysis machine will generally sound an alarm to indicate blood leakage.

Compared with the detection of blood leakage by nurses' inspections, because the dialysate flow rate is very high, it cannot be detected in the first time by naked eye observation alone. In clinical practice, more blood leakage detectors of dialysis machines are needed. The blood leakage monitoring detector is a device that detects blood leakage using photoelectric principles and other methods. Blood leakage is monitored by the light transmittance of the dialysate. If there is blood mixed in the dialysate, the light transmittance of the dialysate is weakened, the photoelectric effect changes, and the machine alarms and automatically shuts down the blood pump to prevent further blood loss. The sensitivity of the photoelectric tube to detect blood leakage is 0.4~0.5ml/L, and the hemoglobin concentration associated with this is 70mg/L. However, the blood leakage detector may also give false alarms, which may be caused by bubbles entering the dialysate, turbid dialysate or contamination of the blood leakage detector. The intelligent blood leakage detection device, that is, the principle of green light detection and infrared compensation, can distinguish true or false blood leakage.

In clinical practice, inspection during treatment is the key. Both are important and cannot be completely dependent on one method.

Response and prevention measures for dialyzer membrane rupture in hemodialysis

When the dialyzer membrane rupture occurs, dialysis needs to be stopped immediately. In order to avoid blood contamination, blood should not be returned. Patients with severe anemia need to consider compensatory treatment. Remove the old dialyzer and dialysis pipeline in time. In recent years, it is recommended to remove the tube and replace the new dialyzer and pipeline for treatment. It is not recommended to force blood transfusion.

The 2021 version of the SOP clearly states that after the membrane ruptures, the arterial and venous ends of the dialysis line should be clamped immediately, and the blood in the extracorporeal circulation should be discarded; however, clinical experience sharing will allow us to do individualized treatment: for cases with small membrane ruptures and positive TMP values, blood will be returned routinely; in addition, with the development of the blood purification industry, the management of treatment-related water quality has become more and more refined; therefore, in addition to TMP considerations, high-quality water quality is also an important guarantee for us to return blood to patients.

After emergency treatment, it is necessary to carefully analyze the causes of the dialyzer membrane rupture incident, learn lessons, and summarize preventive measures. In the operation process of hemodialysis, all staff need to learn the knowledge of dialysis membrane rupture prevention, such as not too high ultrafiltration volume, close monitoring of venous pressure transmembrane pressure and other pressure tests, to avoid coagulation and high transmembrane pressure in the dialysis extracorporeal circulation.

During priming and treatment, the operating procedures must be strictly standardized to avoid situations such as the reverse connection of the replacement fluid tube, failure to use anticoagulants, failure to monitor venous pressure, and opening the blood pump without opening or closing the blood circulation circuit. It is also necessary to adjust the anticoagulation regimen in a timely and reasonable manner to reduce the risk of dialyzer clotting; regularly evaluate the function of the arteriovenous fistula, and prevent and promptly treat complications such as arteriovenous fistula stenosis and thrombosis.

How Does Cistanche Treat Kidney Disease?

Cistanche is a traditional Chinese herbal medicine used for centuries to treat various health conditions, including kidney disease. It is derived from the dried stems of Cistanche deserticola, a plant native to the deserts of China and Mongolia. The main active components of cistanche are phenylethanoid glycosides, echinacoside, and acteoside, which have been found to have beneficial effects on kidney health.

Kidney disease, also known as renal disease, refers to a condition in which the kidneys are not functioning properly. This can result in a buildup of waste products and toxins in the body, leading to various symptoms and complications. Cistanche may help treat kidney disease ase through several mechanisms.

Firstly, cistanche has been found to have diuretic properties, meaning it can increase urine production and help eliminate waste products from the body. This can help relieve the burden on the kidneys and prevent the buildup of toxins. By promoting diuresis, cistanche may also help Reduce high blood pressure, a common complication of kidney disease.

Moreover, cistanche has been shown to have antioxidant effects. Oxidative stress, caused by an imbalance between the production of free radicals and the body's antioxidant defenses, plays a key role in the progression of kidney disease. ies help neutralize free radicals and reduce Oxidative stress, thereby protecting the kidneys from damage. The phenylethanoid glycosides found in cistanche have been particularly effective in scavenging free radicals and inhibiting lipid peroxidation.

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In addition to these direct effects on the kidneys, cistanche has been found to have beneficial effects on other organs and systems in the body. This holistic approach to health is particularly important in kidney disease, as the condition often affects multiple organs and systems. che has been shown to have protective effects on the liver, heart, and blood vessels, which are commonly affected by kidney disease. By promoting the health of these organs, cistanche helps improve overall kidney function and prevent further complications.

In conclusion, cistanche is a traditional Chinese herbal medicine used for centuries to treat kidney disease. Its active components have diuretic, antioxidant, anti-inflammatory, immunomodulatory, and regenerative effects, which help improve renal function and protect the kidneys from further damage. , cistanche has beneficial effects on other organs and systems, making it a holistic approach to treating kidney disease.