CHBT Alarm Systems and Emergency Response 2 — Questions and Answers
Question 1: A patient develops sudden rigors (shaking chills) and high fever 20 minutes into hemodialysis. This is most consistent with:
- Pyrogenic reaction from endotoxin contamination in the dialysate or water (Correct answer)
- Normal autonomic response to the initiation of dialysis in some patients
- Hypoglycemia due to glucose removal by the dialysate
- Hyperkalemia from potassium movement during dialysis
Correct answer: Pyrogenic reaction from endotoxin contamination in the dialysate or water
Pyrogenic reactions (fever, rigors, hypotension) occurring early in dialysis are caused by bacterial endotoxins or gram-negative bacteria in contaminated water or dialysate. Treatment must be stopped, the water system investigated, and the patient managed supportively.
Pyrogenic reactions (fever, rigors, hypotension) occurring early in dialysis are caused by bacterial endotoxins or gram-negative bacteria in contaminated water or dialysate. Treatment must be stopped, the water system investigated, and the patient managed supportively.
Question 2: What is the 'venous pressure alarm' high limit designed to detect in a hemodialysis circuit?
- Obstruction in the venous return line such as a kinked tube, clotted filter, or access stenosis (Correct answer)
- Excessive anticoagulation causing the blood to become too thin
- Low blood pressure in the patient requiring fluid bolus
- Depletion of the heparin syringe in the infusion pump
Correct answer: Obstruction in the venous return line such as a kinked tube, clotted filter, or access stenosis
A high venous pressure alarm indicates resistance to blood returning to the patient. Common causes include a kinked venous line, clotted venous chamber, needle malposition, or access stenosis. It must be investigated promptly to prevent circuit rupture.
A high venous pressure alarm indicates resistance to blood returning to the patient. Common causes include a kinked venous line, clotted venous chamber, needle malposition, or access stenosis. It must be investigated promptly to prevent circuit rupture.
Question 3: When a patient reports sudden severe back pain and difficulty breathing during hemodialysis, the technician should consider:
- Acute hemolysis from a dialysate error, and treatment should be stopped immediately (Correct answer)
- Muscle cramp from aggressive ultrafiltration that will resolve with saline bolus
- Normal discomfort from prolonged sitting that requires position change
- Hypotension from excessive fluid removal requiring Trendelenburg positioning
Correct answer: Acute hemolysis from a dialysate error, and treatment should be stopped immediately
Sudden back/chest pain with respiratory distress during dialysis should raise concern for acute hemolysis (from hypo-osmolar or overheated dialysate), air embolism, or anaphylaxis. Treatment must be stopped and blood must NOT be returned in hemolysis. Emergency response is required.
Sudden back/chest pain with respiratory distress during dialysis should raise concern for acute hemolysis (from hypo-osmolar or overheated dialysate), air embolism, or anaphylaxis. Treatment must be stopped and blood must NOT be returned in hemolysis. Emergency response is required.
Question 4: The arterial pressure alarm (low limit) on a hemodialysis machine is triggered. What does this most commonly indicate?
- Inadequate blood flow from the access, such as needle malposition, access stenosis, or hypotension (Correct answer)
- Too much heparin causing blood to flow too freely through the circuit
- The arterial blood pump is running too fast for the dialyzer
- Air bubbles in the arterial drip chamber
Correct answer: Inadequate blood flow from the access, such as needle malposition, access stenosis, or hypotension
Low arterial pressure indicates the blood pump is not getting enough blood from the access. This may be due to needle malposition, access dysfunction, patient hypotension, or the patient rolling onto the access. It must be corrected to maintain adequate treatment delivery.
Low arterial pressure indicates the blood pump is not getting enough blood from the access. This may be due to needle malposition, access dysfunction, patient hypotension, or the patient rolling onto the access. It must be corrected to maintain adequate treatment delivery.
Question 5: What is a 'concentrate alarm' on a hemodialysis machine?
- An alert indicating the acid or bicarbonate concentrate container is empty or improperly connected (Correct answer)
- An alert indicating the dialyzer is saturated with solutes and needs replacement
- A warning that the patient's blood glucose is critically low
- A notification that the RO water pressure has dropped below minimum
Correct answer: An alert indicating the acid or bicarbonate concentrate container is empty or improperly connected
Hemodialysis machines mix two concentrates (acid and bicarbonate) with purified water to create dialysate. A concentrate alarm means one or both containers are empty, misconnected, or the conductivity cannot reach target, triggering automatic dialysate bypass to protect the patient.
Hemodialysis machines mix two concentrates (acid and bicarbonate) with purified water to create dialysate. A concentrate alarm means one or both containers are empty, misconnected, or the conductivity cannot reach target, triggering automatic dialysate bypass to protect the patient.
Question 6: A patient on hemodialysis suddenly becomes unresponsive. After confirming unresponsiveness, the first action is:
- Activate the emergency response system (call a code) and begin BLS/CPR assessment (Correct answer)
- Stop the dialysis treatment and call the nephrologist's office for guidance
- Administer a saline bolus for presumed hypotension before calling for help
- Recheck the patient's blood pressure and wait 2 minutes to reassess
Correct answer: Activate the emergency response system (call a code) and begin BLS/CPR assessment
An unresponsive patient is a cardiac/medical emergency. The emergency response system must be activated immediately (call a code). While waiting for help, assess airway, breathing, and circulation, and begin CPR if indicated. Dialysis treatment is a secondary concern.
An unresponsive patient is a cardiac/medical emergency. The emergency response system must be activated immediately (call a code). While waiting for help, assess airway, breathing, and circulation, and begin CPR if indicated. Dialysis treatment is a secondary concern.
CHBT Alarm Systems and Emergency Response 2
A patient develops sudden rigors (shaking chills) and high fever 20 minutes into hemodialysis.
This is most consistent with: