Leak? What Leak?

[PrimeTimer]

Hubby says the tech pressed GO and then noticed blood leaking at a connection or somewhere up near the (Fresenius) machine. Needless to say, he lost some blood but only on the arterial side because she had just turned on the machine and it hadn't circulated far enough over to the venous at that point. When we were doing home-hemo using NxStage, we never had a leaky connection or faulty/leaking tubing. Wouldn't the tech have noticed a leak while priming? Geez...just when his hemoglobin is back up to 11.5 this happens. He's feelin it.     They filled out a report but his Neph probably won't hear about it til his next labs. 

[MooseMom]

Well, that's unnerving!  Is he feeling better now?

[cassandra]

Very unnerving indeed, how is he now?

Love, Luck, strength, Cas

[Simon Dog]

Fresenius machines (usually the  2008 series in the US) and NxStage machines use the same luer lock connection, which is why you can use the same needles on both systems.   The tech would not notice a leak at the connection of a needle line to the dialysis tubing at prime time because that connection is not established at that point.  There are some additional points in the 2008k tubing (like the heparin line, and the line to tap air off the chambers) that can come loose and allow for blood leakage.

Fresenius considers any loss of > 50ml of blood in the clinic "reportable" (which I believe means someone has to write a memo).   The clinic I use requires a new HGB test after I report any blood loss (which fortunately hasn't happened in ages).   

The most important thing is that sterile procedure not be  compromised if there is a leak.  There was a big suit when a tech reconnected a cath line after it became detached (in violation of clinic policy), the patient got a cardiac infection, and expired.   Sometimes the best thing to do is say "F it" (loudly and clearly); discard the blood in the line/filter set; and report to the medical team for follow up HGB monitoring.

Just remember, you can't make an omlette without breaking some eggs, and some days you are the egg.

[PrimeTimer]

He's feeling a little fatigue but doing okay. I just wonder how a leak in the line wasn't discovered when the tech primed the machine. My husband insists it wasn't a leaky "connector" but I wonder if that's what it was. Otherwise I'd think saline would have leaked out (from tubing) during priming and be noticed before needle sticks and blood lines connections are performed. I am not familiar with those big machines Fresenius uses or their tubing for that matter. I'm just trying to picture what happened. I'm not upset with the tech, hubby likes his crew but I do wonder how this happened.   

[PrimeTimer]

Fresenius machines (usually the  2008 series in the US) and NxStage machines use the same luer lock connection, which is why you can use the same needles on both systems.   The tech would not notice a leak at the connection of a needle line to the dialysis tubing at prime time because that connection is not established at that point.  There are some additional points in the 2008k tubing (like the heparin line, and the line to tap air off the chambers) that can come loose and allow for blood leakage.

Fresenius considers any loss of > 50ml of blood in the clinic "reportable" (which I believe means someone has to write a memo).   The clinic I use requires a new HGB test after I report any blood loss (which fortunately hasn't happened in ages).   

The most important thing is that sterile procedure not be  compromised if there is a leak.  There was a big suit when a tech reconnected a cath line after it became detached (in violation of clinic policy), the patient got a cardiac infection, and expired.   Sometimes the best thing to do is say "F it" (loudly and clearly); discard the blood in the line/filter set; and report to the medical team for follow up HGB monitoring.

Just remember, you can't make an omlette without breaking some eggs, and some days you are the egg.

Thanks, Simon Dog. I now see what you are talking about...dummy me, I finally googled and watched a youtube of a 2008K being loaded which is what I should have done in the first place. And yes, I am very concerned about infection. He said the tech immediately attached saline-filled syringes to his needle lines and primed a new circuit so he could get a full treatment. She was masked and gloved but still...I am watching him like a hawk for any symptoms. So far, he seems to be okay. This happened Wed, the day before Thanksgiving so more than 48 hours have passed. I marked it on the calendar and counting for the next 10 days tho. 

[Simon Dog]

primed a new circuit so he could get a full treatment

Good move on the part of the tech.  He should be OK.

[KatieV]

The most important thing is that sterile procedure not be  compromised if there is a leak.  There was a big suit when a tech reconnected a cath line after it became detached (in violation of clinic policy), the patient got a cardiac infection, and expired.   Sometimes the best thing to do is say "F it" (loudly and clearly); discard the blood in the line/filter set; and report to the medical team for follow up HGB monitoring.

Just remember, you can't make an omlette without breaking some eggs, and some days you are the egg.

I'm on NxStage and have had days like that!  Once when I was snapping and tapping, the saline/dialysate line fell apart.  It touched the floor and shot saline everywhere!  But at least I wasn't connected yet!  I said some bad words and restarted with a new cartridge.

Sounds like the tech was on top of the issue.  Hopefully your husband just lost a little blood.