Management when prescribed blood flow for dialysis is not achieved

In order to achieve adequate dialysis, it is important that blood flow achieved from vascular access is sufficient to allow adequate toxin clearance and fluid removal. If blood flow is suddenly lower than expected the procedure below should be followed

Exception:

• The fistula is newly formed, assessed as sufficiently mature and within the first two weeks of needling with a reduced blood flow
• patient with cardiac / medical problems that have  a prescribed lower blood flow

Actions if blood flow less then 200ml/min

General:

1. Check tubing for kinks and straighten  tubing if needed
2. Resume blood pump. If prescribed blood flow is achieved-no further action is needed
3. If blood flow remains at <200 ml/fluid challenge by infusing boluses  of 0.9% sodium chloride
4. Consider whether to continue treatment session at such blood flow. Check urea/electrolytes  or spot potassium level to ensure safe to terminate  dialysis
5. Review anti-coagulation prescription, dosing may need to be increased if there is evidence of clotting in the circuit
6. Ensure close observation of circuit, document treatment and actions. Ensure any  necessary follow up

For patients with arterial venous fistula/graft:
Stop blood pump, recheck positions of needles, flush needles with 0,9% sodium chloride for injection. If arterial venous fistula/graft doesn't flush, refer to access team urgently

For patient with kidney dialysis catheter:

1. Stop blood pump. Reposition the patient and flush lumen with 0,9%sodium chloride for injection
2. If a blood flow is achieved but still below the patient's prescribed blood flow, consider intra-dialysis infusion