AIR DETECTION ALARM TROUBLESHOOTING DR JIGAR SHRIMALI
62 year old male, who is k/c/o DM, HTN, CAD, CKD STAGE 5D on thrice a week MHD. At the end of the dialysis, as per nephrologist’s prescription intravenous 7% Amino Acid solution was started at the end of dialysis. This solution when came to end, the technician forgot to clamp the line and that led to air in the blood circuit. So the technician tried to aspirate the air from the blood circuit but again in hurry he forgot to clamp normal saline IV set when paint was good empty.
So we can see that the whole IV set was full of blood.
This could have become the reason for death of the patient and the reason was not following proper steps for troubleshooting. So let’s understand troubleshooting of air in the blood circuit.
| Cause | Resolution
|
| Air or micro foam visible in the drip chamber. | Remove air from the arterial drip chamber or venous line.Ensure all connections are securely on. Check all connections, including access, filter, caps and Heparin connections for sources of air leaks. |
| Air or micro foam visible in the drip chamber or blood circuit. | Disconnect both, arterial and venous line from patient and keep it in rotation. (Steps are described at the end of the table.)
Ensure all connections are securely on. Check all connections, including access, filter, caps and Heparin connections for sources of air leaks. |
| The venous chamber is not properly positioned in the air detector. | Ensure venous chamber is placed properly and not “pinched” within the air detector. |
| The blood level is too low in the drip chamber. | Raise the blood level in the drip chamber.
|
| Air detector sensors are dirty.
|
Clean the sensors. |
| The air detector is faulty. | Replace it and till the time don’t use the machine. |
| Turbulence close to sensor. | Override alarm. |
To remove air from the blood circuit*:
Step1. Disconnect the patient from the extracorporeal circuit (blood circuit), attach arterial and venous end of blood circuit through connector and start recirculation. Connect normal saline through saline port.
Step 2. Attach a syringe to a small line of the venous chamber and clamp the line of the venous pressure so that there will not be any major fluctuation in venous pressure during the whole process of air removal otherwise these pressure differences will create repeated venous pressure alarms. Remove all air from the venous chamber with the syringe.
Step 3. Start the pump for 2 minutes and during that keep the dialysis machine in prime mode and remove the venous chamber from the air detector. During this period saline will replace the air space and air will get collected in arterial or venous chambers and that can be removed through syringe again.
Step 4. During this process closely observe dialyser for air trapping. If air is trapped in dialyser pinch venous line so that air can be removed soon.
Step 5. Once it looks that air is removed place the venous chamber back into the air detector and resume treatment with recirculation and check for air detection alarm.
Step 6. If no air detection alarm, resume treatment after venous pressure clamp is released and venous chamber is placed back in air detector. And then only patient to be attached again.
Article Courtesy – Dr. Jigar Shrimali
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