Intradialytic Monitoring, Complications and Emergency Management
The Intradialytic Monitoring, Complications and Emergency Management domain tests pre-, intra- and post-dialysis assessment and rapid recognition of hypotension, cramping, disequilibrium, reactions, air embolism and hemolysis.
Core rules
- Monitor BP, pulse, symptoms, UF rate and access function; recheck after any intervention.
- Hypotension: stop UF, place the patient in Trendelenburg, give a saline bolus per protocol and reassess; avoid rapid large fluid boluses without orders.
- Dialysis disequilibrium: headache, nausea, confusion or seizures; reduce Qb, stop UF and treat urgently.
- Air embolism: clamp lines, stop the pump, place the patient in left lateral Trendelenburg, give oxygen and call for help.
Worked example
BP falls to 82/50 with nausea at 2 hours. Stop UF, lower the head of the bed, give 100–250 mL normal saline per protocol and recheck BP. If there is no response, escalate and evaluate for bleeding, sepsis or cardiac causes.
Traps
Do not continue UF through symptoms; do not confuse anaphylaxis with hypotension; do not give potassium during a reaction; do not delay emergency activation for air embolism. Post-dialysis, reassess weight, BP and bleeding.