Potential Hemodialysis, Access or Catheter Problems

Most of the physical problems associated with hemodialysis occur due to the fact that it is an intensive treatment, as all the dialysis is condensed into a few sessions a week. The information listed below is given only as a guide, patients suspecting problems are advised to seek further information from their own doctor.

  • Rapid changes in blood pressure: The speed at which water is removed from the blood during hemodialysis causes a sharp drop in blood pressure, which can make some patients feel unwell, either during or after the treatment session. Fainting, vomiting, cramps, temporary loss of vision, chest pain, irritability and fatigue can all occur.

  • Fluid overload: People with advanced kidney failure pass little, if any urine. This means they often retain extra fluid in their bodies. This can cause an increase in weight and blood pressure. Symptoms include: swollen ankles, puffy eyes, and shortness of breath. Patients with fluid overload will need to maintain their prescribed target weights, limit their fluid and salt intakes as recommended by their doctor, and monitor their blood pressure.

  • Hyperkalemia: This condition occurs when there is too much potassium in the blood, which can interfere with the heart's rhythm. In severe cases of hyperkalemia, it can cause the heart to stop. Most hemodialysis patients are asked to restrict their intake of foods which contain a lot of potassium.

The following problems are related to the access:

  • Infection: can be a problem. To avoid this, the skin covering the access will be cleaned thoroughly before inserting the needles. Any redness or signs of infection should be quickly reported.

  • Clotting: Some people have problems with blood clots that grow in the fistula or graft. These clots are not life threatening because they do not travel to the heart or lungs. However, they can permanantly block access and need to be removed by surgery. (Patients should check every day to make sure blood is flowing through the fistula or graft. This is done easily by lightly touching the area to feel for a pulse. Notify your doctor if you think the access is clotted.)

The following problems can occur with your catheter:

  • Infection: Signs of infection are fever, chills, swelling, drainage at the exit site, redness, or tenderness. You may feel unusually tired or have nausea or vomiting. Call your doctor if you experience any or all of these symptoms. You may have an infection and may need an antibiotic.

  • Bleeding: If blood is leaking from your catheter, stop the bleeding by pinching, clamping or tying off the end of your catheter. Call your doctor.

  • Clotted catheter: Some people have problems with clotting in their catheter. This is discovered when the nurse tries to start dialysis and cannot get a blood return. When this happens, the nurse will notify your doctor for further orders. Sometimes a medicine that dissolves blood clots can be injected or the catheter may need to be replaced.

  • Pneumothorax (Air in the lung): If you experience shortness of breath or chest discomfort within hours after your catheter is inserted, you may have air in your lung space. This is a MEDICAL EMERGENCY. CALL 911 and sit quietly in a position that is comfortable until help arrives.
  • Air in the catheter: This may occur if your catheter is cut or the cap is removed accidently. If this occurs, you may have shortness of breath, chest pain or pass out. This is an EMERGENCY. Clamp the catheter immediately near the exit site if the catheter has been damaged or the cap has come off. If the damage to the catheter is between the clamp and your skin, tie a knot in the catheter close to where the catheter enters your skin. You may also bend the catheter over and hold it closed by tightly placing a rubber band or plastic twist tie. Lie down on your left side with your head down and your feet elevated. Call 911 or your doctor immediately.

DISCLAIMER: This website offers basic helpful information for people with kidney disease and their caregivers, family and friends. This information should not be used for diagnosing a health problem or disease; visitors should always consult their own physician.