Has Anyone Experienced This?

[Genlando]

For the last couple of months, I've experienced a suffocating sensation every time that a nurse administers an injection during hemodialysis.  It's not shortness of breath--it's suffocation.  I can't inhale, and I start coughing, like something is blocking my throat.  I was ambulanced to the hospital the first time this happened, but they didn't find anything wrong.  Here's the sequence of events that lead up to an episode:

1) Nurse opens the line connected to the saline bag.
2) They administer the injection and wait a few seconds.
3) They close the line leading to the saline bag.
4) After approximately 30 seconds, I start suffocating. 

A mild episode goes away after a minute or so by itself; a severe episode requires oxygen, and may go on several minutes.

This is not low BP.  My diastolic usually stays around 90 throughout the treatment.  I don't drink a lot of fluids, so they rarely have to draw off more than 1.5-2.0 kilos at any time, and my dry weight hasn't changed.  Besides, I'm familiar with the symptoms of hypotension / excessive fluid removal, and this doesn't feel like it. 

After several episodes of this, I started asking the nurse to administer any injections directly into the venous port, so that they wouldn't need to use any saline.  This has worked fine for several weeks, until the evil center-director said that the nurses couldn't continue doing this--concerns about getting stuck while doing this.  I understand about safety concerns, etc.  They did an injection today using the saline-mix method, and sure enough, I started suffocating.  This isn't something I'm imagining, because I was asleep when the nurse did the injection, and I woke up with the wonderful sensation of suffocating.  If you haven't ever had that feeling, I'd recommend it to anybody; it's quite invigorating. 

I've had a couple of episodes happen when the Neph.'s were watching, and they're stumped.  Here's a couple of theories that I've come up with (understand that I'm just a country bumpkin from South Carolina, so don't expect too much):
1) I'm mildly allergic to either the dialysate or the dialyzer, and it jumps over the top whenever they do the saline trick.
2) I'm experiencing cavitation in my heart/lungs due to a difference in my blood's viscosity when they do the saline exchange (sorry, I forgot to mention I still have a permacath in; I'm waiting for my fistula to mature).

My cardiologist put me through a stress-test, and said that there are no problems with my heart.  Incidentally:  I don't have any problems during the put-on procedure, when they use a bunch of saline.   I had a mild reaction once when coming off, but it hasn't happened since then.

Of course, the nurses all think that this is all my imagination; but like I said, this morning, I had it happen while I was asleep.  So, what do ya'll think?

[Restorer]

Could it be related to the temperature of the saline? I'm guessing it doesn't happen at the end of every session, so when they do the rinseback at the end, do they warm the saline? (They don't always do that at my unit.)

When I get an injection (I have a permacath too), I can taste/smell the saline, and I feel like I need to cough briefly because of the cold saline. If it has to do with the temperature, maybe you're having some kind of muscle spasm. I suppose it could also be another type of reaction to the bolus of saline right into your heart/lungs. I'll be surprised if it still happens once you start using your fistula.

Just guessing at what makes sense to me. 

[chiefsfan301]

I have a fistula and it happens during rinse back.

[Hubbs]

yep, but i don't have a reaction..  i'm thinking they are pushing it too fast for you. when i am feeling it in my lungs and throat, i tell them that's enough..  Nasty!   

[Genlando]

Thanks for all your responses.  I'll definitely ask them to warm my saline before infusion.  And Hubbs, are you saying that you experience similar when the techs have your flow rate set too high?   They typically set me to run at 350-400 cc through my permcath.  This might be too high in my case.