Wednesday, March 18, 2009

Bloody air bubbles

Well, literally!

Day before yesterday was Monday. On Mondays, I like to get onto dialysis early so that there is enough time to pull off the excess fluid that I have had on Sunday (I do not dialyze on Sundays). So, I got home, quickly had my dinner and started setting up the machine. I did not want to wait for the tech because he would come late anyway.

Everything went off well. Preparing the bicarbonate solution, priming a new dialyser (artificial kidney) and a tubing set. I then cannulated and connected myself and started the blood flow. In the last stage of the starting process, however, the Air Bubble Detector alarm went off. I tried the usual "Reset" button. To no avail. It kept going off no matter what I did.

I noticed that a large number of air bubbles had accumulated on both the ends of the dialyser. I was surprised. When I had finished priming, I had checked both the ends and there was no air bubble. How then did they get there?

Air bubbles are a serious issue in dialysis. The air should not get in to the blood that is going back into the body after passing through the dialyser. It can cause a potentially life threatening condition called Air Embolism. Dialysis machines are designed to detect any air in the blood usually by means of a sensor that is placed a little before the blood makes its way back to the body after passing through the dialyser. If any air is detected, the machine stops the blood from going back.

So, here I was, blood already out of my body and air bubbles gathered in the dialyser, not knowing what to do. Training! That's why training formally is so important. To be able to handle situations like these. I shouted out to my brother and asked him to dial the tech from my cell phone and put him on speaker. I explained what was happening. He asked me to try a couple of things. Didn't help. He said he would immediately come home.

The next 15 odd minutes were excruciating.

The blood was out of my body. I watched helplessly as the blood lay motionless in the tubes on the machine. I started wondering if all this was worth it. Whether I should ALWAYS wait for the tech to start dialysis and not do it myself. These things were rare. I had started dialysis myself many, many times and nothing had ever happened. But when something like this happens, you really feel scared. The whole process of hemodialysis is so violent with blood outside the body.

The tech came and immediately hit the dialyser against his hand repeatedly to make sure the bubbles came out of the dialyser and into the venous chamber. He went into priming mode for a few minutes while he did this. Within a few minutes, all the air bubbles were out of the dialyser and the session proceeded normally.

I am at a loss as to what to make of this. Should I aim for more independence by starting dialysis myself? Or should I not take any chances? What was the worst that could have happened? Is the independence worth the risk?

5 comments:

IGA Nephropathy said...

Oh Man ! Glad to hear that it was resolved. It was good that the tech was able to come right away and infact he was trained adequately to deal with this.

How does this work in US?...are the nxstage machines different?..because I cannot imagine how folks in the US deal with such things and if it is part of 'training'..is it available on the net somewhere so that you can go through it yourself ?

Guess this incident is related to my earlier comment on daily dialysis.

Madras Hash said...

You will need to train one or more of your family members to deal with an emergency like this one. The technician can perhaps provide the training. Ofcourse, this assumes that the person is not squeamish when it comes to dealing with blood in tubes or dripping from your body.

Till then, I would suggest that you ask your techie to come in earlier on Mondays

Kamal Shah said...

In the US, things are different because of 2 things. First, the NxStage machine is much, much simpler. It is designed for home use. Second, every individual who is going to dialyse at home undergoes a 6 week training.

Nothing on the internet in terms of training. It is all hands on and oral.

Also, in the US, every patient who dialyzes at home is hooked to a center where he can call and there are trained experts to help him/her handle any situation. May centers even have the machines hooked up and sending data continuously to the center over the internet where someone monitors it continuously.

Kamal Shah said...

Mondays are bad for everyone. The tech is very busy because there are more emergency dialysis treatments because it is just after the 'killer weekend'. That is why the petition for every other day dialysis.

billpeckham.com said...

I don't think you were in danger from a few bubbles - you'd need to have a few CCs of air at once for it to be a problem and there was the venous drip chamber between the bubbles and your arm.

When you're priming you'd want to bang around the dialyzer to get all the fibers primed and flush all the air to the air trap. Most likely what happened is that some of the fibers weren't primed until the blood hit the kidney.

It's a learning process - add bang around the kidney to your checklist. It would be far more dangerous to get less dialysis and I really think the more you take responsibility for your treatment the better off you will be in the long term. Taking responsibility to me means you learn from mistakes and now you move on.

I say no blood loss, no foul. (An American basketball reference, not sure what the cricket equivalent would be)