Fizzy "Cherry Pop" Coming From Patient?

[westieluv]

I was taught when I started working in dialysis that a fizzy, "cherry pop" quality to the blood in the blood lines indicates hemolysis. A few days ago, I noticed this type of blood in the arterial tubing coming from the patient, who appeared to be asleep. The venous line looked fine. My first thought was hemolysis. The tech who was nearby got wide eyed and said, "I've never seen that before in my life!" so I really thought it was a major issue.

The patient woke up and seemed fine, and then I felt stupid for suggesting to the rest of the staff that she might be having hemolysis. Was I way off base in my thinking? Does hemolysis normally show up in the venous line instead of the arterial line? I learned all of this at one time, but I am just now getting back into dialysis after a couple of years' break and the learning curve is tougher than I thought it would be. I worried all weekend that I made a fool of myself suggesting hemolysis in this situation, but why would fizzy, pinkish, blood be coming from the patient? I could see it if it was in the venous line because of air in the line, but it wasn't.

[Chisca, RN]

Recirculation? What did the venous side access pressures on the machine look like?

[westieluv]

Venous pressures were fine. Once the patient was wakened and repositioned, the blood returned to normal and she finished her treatment.

Someone I was telling this to yesterday who is very experienced in dialysis like you also suggested recirculation so I know that is probably the case, but it resolved when she moved in her chair, and I don't understand how this would fix that, since my understanding is that recirculation is caused by the needles being placed too close together.

[Chisca, RN]

Anything that blocks venous return (stenosis, tourniquet, body position compressing vein) can cause recirculation. If you see this patient again try letting 100cc of saline in on the arterial side and watch it go through the machine and see if it comes back through the arterial side.

[westieluv]

Thanks, Chisca, I appreciate the information. I guess I should have known that, but I'm still getting my dialysis feet wet again (not literally...yet, lol) after spending the past 2+ years doing something completely different and thinking that I would never work in dialysis again. I"m glad you're here to bounce things off of, because you are very knowledgeable!

[Chisca, RN]

Sometimes all you know is that something just isn't right. Trust that instinct.

[jlautier]

If the patient has a CVC, recirculation will always occur because the tips of the catheter are only .1 mm appart from each other. Especially if the catheter is running reverse than a higher percentage will be recirculating during the tx. That small space between catheter tips in the atria also make it difficult to achieve an adequate BFR. With an asymptomatic patient I would assume the patient's system was beginning to clot. What was the BFR, DFR, KECN's, and spkt/v for this treatment? Was the patient meeting adequacy? (green light) ?