The principal reasons for a true blood leak are defective dialyser membranes, excessive trans-membrane pressure, and rarely haemolysis (Daugirdas and Ing. 1994).
A blood leak is classified as minor when microscopic blood is detected by the monitor, and confirmed by labstix if available and no visual blood is seen.
A major blood leak results in a macroscopic loss of blood into the waste dialysate line.
A false blood leak results when the detector incorrectly identifies a blood leak. This can result from debris in the area of the detector, or in the dialysate fluid, or excessive air in the waste dialysate line. The management is to ensure that there is no blood present, and to call for technical assistance. If it cannot be cleared immediately, the machine must be withdrawn from service for maintenance.
PURPOSE
The principal reasons for a true blood leak are defective dialyser membranes,
1. To prevent blood leak during haemodialysis through attention to following manufacturers instructions for the testing of haemodialysis machines before commencing haemodialysis
2. To prevent complications related to blood leak e.g. haemolysis, septicemia.
3. To ensure staffs are educated about true and false blood leaks and their management.
CONDITIONS
1. Two (2) nurses, of whom one should be an experienced dialysis nurse should be carry out this procedure.
2. Applies to all Registered Nursing Personnel working in the dialysis centres
3. This procedure can be performed by a nurse undertaking nephrology / dialysis training programme, provided he / she is closely supervised by an experienced dialysis nurse at all times.
Alert
1. All renal nurses must be aware of the complications of hazards that may occur due to blood leak during dialysis
2. All renal unit nurses must be able to differentiate a true blood leak from a false one.
3. A functional test must be completed on all machines prior to commencing haemodialysis to ensure patient safety and well being
4. All the circuit must be checked to ensure connections are secure (repeated if there are changes made to the circuit during haemodialysis to ensure patient safety and well being
5. The blood leak sensitivity control knob must be kept at maximum e.g. 10 at all time (Gambro machine)
6. A spare machine must be kept ready at all times for the use in case of emergencies e.g. faulty blood leak detector
7. Ensure that the patient is aware of the hazard and reassure him/her to allay fears and gain his/her confidence and cooperation
PROCEDURE
A – Minor Blood Leak
| SN | Nursing Action | Rationale |
| 01 | When blood leak alarm occurs, check for faulty blood leak detector and if so call for technician assistance. | To avoid confusion and save time. |
| 02 | Explain the procedure to the patient. Allow him/her to ask questions. | To gain confidence and cooperation. |
| 03 | Check the dialysate lines for discoloration. | To ensure whether it is a real blood leak or just a machine error or faulty alarm. |
| 04 | Collect 10 mls of dialysate in a test tube and visually check for blood. Check with labstix if available. | To decide whether it is minor or major blood leak. |
| 05 | Return the blood if a minor blood leak is verified. | To prevent massive blood loss. |
| 06 | Return the dialysis line in the lock. The alarm should stop when the line are clear (no blood). | |
| 07 | Put the machine on rinse programme. | To clear blood from the dialysis lines. |
| 08 | Re-assess the patient and decide whether to recommend dialysis. | To ensure delivery of prescribed treatment. |
| SN | Nursing Action | Rationale |
| 09 | Document the incident including the time, when the blood leak started, nursing intervention, the patient condition and the amount of blood lost (if any). |
B – Major Blood Leak
| SN | Nursing Action | Rationale |
| 01 | If blood leak is massive and the blood cannot be re-infused, send a blood sample to check for haemolysis and inform the physician on call. Nursing Alert When a blood leak occurs, there is a risk of blood contamination from un-sterile dialysate entering the compartment of the dialyser. | To identify the blood loss and check haemoglobin. |
| 02 | Put the machine on rinse programme. | To clear blood from the dialysate lines. |
| 03 | Take and record vital sings | To monitor the condition of the patient. |
| 04 | Re-assess the patient. | To allay fears and gain patient’s confidence and cooperation. |
| 05 | Document the incident including the time, when the blood leak started, nursing intervention, the patient condition and the amount of blood lost (if any). | |
| 06 | Document the lot N0. of kidney and Serial N0. | To report to the company. |
