Synopsis
Recognise time-critical haemodialysis and peritoneal-dialysis complications, stabilise the patient and access, and activate the correct renal, vascular, infection or resuscitation pathway.
- Major haemorrhage from a fistula, graft, needle or disconnected circuit is immediately life-threatening: summon emergency help, stop the pump when relevant and apply firm direct pressure to the exact bleeding point.
- A previously functioning fistula with an absent or abruptly changed thrill may be thrombosed; protect the limb and contact the renal access team urgently because salvage becomes more difficult with delay.
- Fever, rigors or hypotension in a person with a dialysis catheter is catheter-related bloodstream infection until assessed, but chest, urine, skin, fistula and peritoneal sources must also be sought.
Key red flags
Uncontrolled access bleeding with shock requires emergency medical services, focused compression and resuscitation; do not release pressure repeatedly to inspect the wound.
Investigation priorities
Distinguish bleeding, loss of flow, infection, aneurysm, outflow obstruction and distal ischaemia.
Management branches
A fistula, graft, needle site or dialysis circuit is bleeding heavily or the patient is haemodynamically unstable.
- Call emergency help, lie the patient safely, expose only what is needed and apply continuous firm direct pressure with a gloved hand and gauze to the precise bleeding point.
- If dialysis is running, trained staff stop the blood pump and clamp affected lines while maintaining pressure and preventing further air entry or blood loss.
Key medicines
Empirical therapy for catheter-related infectionAdminister the local dialysis-adjusted intravenous regimen after cultures, timed around haemodialysis and modified for allergy and prior isolates.
Thrombolytic catheter lockInstil only the product-specific lumen volume and dwell prescribed by trained renal staff for suspected intraluminal catheter occlusion.