Unit of blood clotting during dialysis

[LaraT23]

I was wondering if anyone else has seen a unit of blood clot in the dialysis lines during the procedure? A patient over the weekend received only 20 cc of a unit because apparently it clotted off in the venous chamber just before it gets to the patient. I kind of think this is the patient's blood that is an issue but I need to write up a QA report as nursing says the unit clotted. Now, this patient was not heparinized per the nephrologist, so wonder if that makes a difference?

[John C. Staley]

Any chance they were using D5W instead of saline at some point in the process. It's been quite some time since I had any direct dealings with dialysis but I seem to remember they use saline quite a bit.

Just a thought.

[Malcolm Needs ☆]

We've just had two cases of a unit clotting (same patient), and I also know of one in the north of England, where it would appear (in fact, definitely, for the one in the north of England) that the unit was taken down to below the level of the canula in the arm, allowing the patient's blood to flow back into the unit, where it clotted.

The one in the north of England was proved by grouping the unit after the clot, and it had mixed-field reactions that included the patient's own minor blood groups.

Our two have been sent off for DNA work.

In both case, surprise, surprise, the nurse looking after the patient denied that this had happened (in the case in the north of England, it happened when the patient went to the bathroom).

:eek::eek:

[SMW]

I would also inquire what else was in or recently in the venous chamber or infused with the product. Was the product returned and were you able to examine the blood in the bag? I've commonly seen similar reports from the OR or other areas and the appearance was consistent with clots formed when a citrated blood product is infused with or through tubing containing a solution with ionized calcium, e.g., lactated Ringer's intravenous solution. Traces of intravenous solutions used to prime administration sets have been reported to remain and be detectable in intravenous tubing as long as 30 minutes after a simulated transfusion was begun.

[heathervaught]

Do you use leukocyte reduced RBCs? If not, it is *possible* that a clot could have formed during collection, was not detected during manufacturing, and was transferred into the dialysis kit. If your products are leukoreduced, then I would find it highly unlikely that the blood component would be the source of the clot.

[sona]

we usually encounter a problem with the blood samples of dialysis patients after centrifugation serum gets like gel i wonder why it happens or does it have any link with Lara's problem:confused: