Hemodialysis Intravascular Hemolysis and Kinked Blood Lines

Abstract

Between May 29 and September 13,1991,4 patients developed acute intravascular hemolysis during hemodialysis with Monitral-S delivery systems and Hospal BSM A77 blood lines. All had malaise, nausea and headache; 3 had severe abdominal pain and 2 became very ill. Plasma hemoglobins were 3-21 g/l and LDH 542-3,300 IU in the 4 patients. Hepatoglobin became unmeasurable in 3 and was 0.09 g/l in the 4th patient. Soon afterwards, we found the arterial blood line tightly kinked at the dialyzer inlet port in the 4th patient and released it; he developed abdominal pain, hemolysis was present. We then found these lines had an extra long pump segment, and the rest was short and fitted poorly. When put in the first tubing organizer, severe kinking could occur just after the pump segment, causing back pressure but no alarm. We produced early visible hemolysis in a 1-liter circulating closed loop blood system with the blood line kinked either at the dialyzer inlet or just below the first arterial line tubing organizer with 40 g/l free plasma hemoglobin by 30 min. We excluded reported causes of intravascular hemolysis during hemodialysis. No hemolysis occurred before or during the 9 months after we discarded BSM A77 lines. The evidence indicates that kinked blood lines caused the hemolysis.

Undetected Excessive Ultrafiltration during Maintenance Haemodialysis

“…There are several reports in the literature to help recog nize haemolysis [1][2][3], Kinks in the arterial line could lead to haemolysis by increased shear stresses in the kink [4] or through a marked increase in the pressure between the kink and the blood pump [2], More recently, Hudson et al [3] described 5 patients on HD using a Gambro AK-10 sin gle-needle, double-pump system who were subjected to excessive rates of undetected UF and significant haemolysis. A kink occurred in the circuit where the flexible tubing joined the venous compliance chamber.…”

Hemolysis as a rare but potentially life-threatening complication of hemodialysis: a case report

“…Hemolysis in this context may be a consequence of a number of biochemical, toxic and mechanical complications during the HD procedure itself. Four major mechanisms capable of inducing hemolysis during HD have been recognized: overheating, hypotonicity of the dialysate, contamination of the dialysate with toxins (e.g., formaldehyde, bleach, chloramine, nitrates) from the water supply, with copper from copper piping and improperly functioning clamps or tubing, such as kinked arterial lines [3-6]. In cases where there is a contamination of the water supply, most of the patients in the concurrent dialysis session can experience similar signs and symptoms associated with hemolysis [4].…”

Wearable Dialysis: What is Missing?

“…If the WAK is put on a stand during the night, the tube connecting the patient to the WAK must be approximately 2 m long -storing this tube in the preferred carrying case during daytime would be challenging. Moreover, it must be pointed out that kinked tubing caused by poor design is known to have caused fatal mechanical hemolysis [22,23].…”