Hemolysis as Cause of Hemodialysis Blood Leak Alarm: Case Study of a Patient with Freshwater Near-Drowning.

Hemolysis may be an infrequent cause of hemodialysis blood leak alarms. We report the case of an unresponsive adult male who was placed on hemodialysis with a high-flux dialyzer. Within five minutes, the blood leak alarm sounded. The care team discontinued treatment and made two additional attempts to reinitiate hemodialysis with different machines, blood tubing lots, and brands of high-flux dialyzers, but continued to receive blood leak alarms. Laboratory studies were consistent with severe hemolysis. The attending nephrologist subsequently ordered continuous veno-venous hemofiltration, which was initiated and continued into the following day without incident or alarm. The patient later expired from complications of near-drowning. In the event of significant hemolysis, continuous kidney replacement therapy or hemodialysis with a low-flux dialyzer, and a lower ultrafiltration rate may be indicated.

Overheated dialysate: a case study and review.

Overheated dialysate has been reported as a cause of fatal hemolysis, both acute and chronic. However, published incidents are several decades old and only include cases where the dialysate was overheated above 47 degrees C or where the temperature was not reported This case study examines an incident where a faulty plumbing valve introduced hot water into a cold line used exclusively ror inpatient dialysis in an intensive care unit, causing the dialysate temperature to raise as high at 39.8 degrees C before the treatment was terminated early. A review of the literature demonstrates that while thermal hemolysis only occurs in temperatures of at least 47 degrees C, patients exposed to overheated dialysate at much lower temperatures may still be at risk for hyperthermia and heat stroke.

Unilateral neglect: assessment in nursing practice.

The North American Nursing Diagnosis Association has recognized unilateral neglect (UN) as a nursing diagnosis for more than 2 decades. Such a designation implies that nurses primarily are responsible for assessing, treating, and researching the disorder. However, nurses have made few documented contributions toward this responsibility. Although UN is a complex problem that requires attention from several specialties, there is room for nurses to substantially increase their role. Nurses are uniquely positioned to assess and treat UN by virtue of their interaction with patients in a variety of times, settings, and activities. Nurses need to develop quantifiable measures of clinical observation that are reliable and valid in nursing practice. This article reviews the literature to examine the impact of UN, existing assessment methods, and nursing involvement in assessment and treatment. Potential nursing contributions in practice and research are featured as well.

Chronic unilateral neglect from focal meningoencephalitis lesions in an immune-compromised hemodialysis patient.

Unilateral neglect (UN) is a disorder associated primarily with right-brain damage; it causes individuals to behave as if the contralesional half of their world has become unimportant or has simply ceased to exist. This is the first known case study to describe and measure UN caused by an infectious process, meningoencephalitis. The patient was immune compromised as a result of antirejection drugs following a kidney and pancreas transplant, as well as from a baseline vulnerability common to patients with hemodialysis. She was reassessed serially during hemodialysis treatments over 12 months and demonstrated improvement in some measures of UN but not in others. UN is a recognized nursing diagnosis and can be assessed, treated, and researched by nurses. Neuroscience nurses need to better understand and investigate UN to improve their own practice and the practice of other specialties.