What are the causes of a pasient "coding" "dying" while on dialysis?

[Des]

I have read the post about a pasient dying (coding) while on dialysis.

I would like to know how this is at all possible? I thought the alarms will warn the staff of any potentional problems BEFORE they occur.

This is not reassuring at all. 

[cloud393]

I have an uncle who had a heart attack while on D.  Fortunately he didn't die.  Although, he had to have treatments at the hospital after that instead of the clinic.

[jbeany]

Unfortunately, the alarms only cover machine function, not human function.  They don't alarm when your blood pressure drops and they certainly don't alarm when your heart beat stops.  So, yes, you can have a crash so bad it stops your heart and the nurses might not even notice.  Many D patients have heart problems as well, and their chances of having a heart attack are higher.  It's thankfully a relatively rare occurrence, but it does happen.  This is why anyone who has been on D for a while appreciates boring.  Boring beats listening to the nurse pound on the chest of the patient in the chair next you, yelling "One two three four five BREATHE!"

The machines also don't always alarm even for machine errors.  If the return blood line comes loose, it's possible to end up with a pool of blood under the patient's chair that no one sees for a while, including the patient who was sleeping when it started.  My center nearly lost someone that way.

It is a risk.  Anything that involves pumping all the blood out of your body and back in again is going to involve risk.  On the other hand, without D, there's no risk of living at all. 

Again, dialysis is NOT for sissies.

[RightSide]

Even if they did provide some kind of real-time heart function monitor at the dialysis center, what about the rest of the time?

It's known that many ESRD patients who get fatal cardiac arrest, get it in their sleep.  They just go to sleep normally at night--and never wake up again.

So the biggest win would be to have some kind of real-time heart monitor that you set when you go to sleep at night, and which will automatically dial 911 for you.

[Des]

Last week we had 2 patients just 'crashing"

An old lady had a diabetic crash..... she just fell asleep and when they woke her for her snack they couldn't wake her. Luckily they could bring her around eventually.(dextrose in the vein)


Friday the guy next to me's blood pressure went so low that he 'fainted" The blood pressure only tests automatically every hour or so, so the machine did not pick it up. SCARY!!!!

They pushed some fluids in him and he came around as well.

I will have to say that THIS IS MY WORST FEAR !!!! I think that cases like these are one of main reasons that I dislike the dialysis process so much.    

I vow to never ever ever fall asleep at the unit while on the machine. So when I do they will know that something is wrong.

[Sax-O-Trix]

Perhaps internal defibrillators should be placed in all D patients who want one as a standard precaution...

[looneytunes]

The two times hubby crashed here at home while on NxStage were pretty scary.  The first time, he actually quit breathing and went into cardiac arrest.  I got to practice my CPR training on him, which thankfully worked.  And HE got to take a helicopter ride to the hospital.  The 2nd time, I happened to be in the room doing a stat check and noticed his BP crashing.  I had already started a bolus when he had a seizure.  Now he checks his BP about every 15 minutes and I turn off the UF if it starts to get too low.   If I were an in-center hemo patient, I would demand they turn the machine to face me and put it close enough to check my own BP more often than the machine does.  Or take my own BP monitor.   The vast majority of patients I have observed in the centers go to sleep during treatment.  So, they may not know when they "feel" weird.  Scary Stuff!  Agreed..."dialysis is not for sissies". 

[RenalSurvivorDotCA]

I have my bp set to take every 1/2 hour for the first 3 hours and then every 20 mins for the remaining 2 hours of my run. If my bp is low or I don't feel good or I don't like the slope of my critline I set it to take bp every 10 or even 5 mins.

You are the patient. YOU should have total control of your treatment. If you feel bad in any way, drop your goal a little or turn off UF for 5 mins to let your vascular system "refill" a bit. Maybe change your UF profile to one less agressive. Your nurse has 3 or 4 other patients to watch, so she can't be everywhere at once. You know the feeling you get when you'r about to sneeze? Well, you know the symptoms, that's how you can tell when a sneeze is coming. Know the symptoms of a crash and alert someone as soon as you experience them.

I've had the misfortune of being seated two times beside patients who have coded. It's very terrifying. My eyes flutter open and I go wide awake whenever I hear "Code Blue, Hemodialysis Unit." over the PA.
I must say that our Code Teams are first rate and they are swarming over the place within minutes.