One of the major complications that occur during haemodialysis is?

SCTIMST Staff Nurse - 2015 (Set-A)

Medical & Surgical Nursing

Easy

Appeared in: SCTIMST Staff Nurse - 2015 (Set-A)

Explanation

Hypotension is the most common acute complication occurring during hemodialysis, affecting 20-30% of sessions.
It results from the rapid removal of fluid (ultrafiltration) from the bloodstream at a rate faster than the body's ability to compensate by shifting fluid into the vascular space.
Factors like excessive fluid removal, autonomic neuropathy (especially in diabetics), and pre-dialysis intake of antihypertensive drugs increase the risk.
Its high frequency and potential for causing significant symptoms (dizziness, syncope, ischemia) make it a major complication requiring immediate nursing intervention.

Option A: While muscle cramps are a common and distressing side effect of hemodialysis, they are not considered as major or life-threatening a complication as severe hypotension.
Option C: Air embolism is an extremely rare event in modern hemodialysis due to advanced safety alarms and monitoring systems on dialysis machines. While it is life-threatening if it occurs, its rarity means it is not a 'major' complication in terms of frequency.
Option D: Pulmonary edema (fluid in the lungs) is a primary indication for performing hemodialysis, as the procedure removes the excess fluid that causes it. Therefore, dialysis treats this condition rather than causing it.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Complications of Hemodialysis as background academic context rather than a clinical decision trigger.
A nurse's primary role during hemodialysis is vigilant monitoring for complications, with hypotension being the most frequent concern.
Nurses must be prepared to act quickly: stopping ultrafiltration, repositioning the patient, and administering saline are critical first steps to prevent patient harm, such as falls or cardiac events.
Patient education is key. Nurses should instruct patients to report symptoms like dizziness, nausea, or yawning immediately, as these are early signs of hypotension.

How to Approach the Question

First, understand the question is asking for a 'major' complication of hemodialysis. 'Major' can imply either high frequency or high severity.
Analyze the options in the context of the hemodialysis procedure.
Recall or reason through the function of hemodialysis: it removes fluid and waste products. This immediately makes 'Pulmonary edema' a questionable option, as dialysis treats it.
Compare the remaining options: Muscle cramps, Hypotension, and Air embolism.
Evaluate their frequency. Hypotension and muscle cramps are known to be common. Air embolism is known to be very rare with modern equipment.
Evaluate their severity and impact on the treatment session. While cramps are uncomfortable, a significant drop in blood pressure (hypotension) is a serious hemodynamic event that requires immediate intervention to continue the treatment safely. Therefore, hypotension is the most fitting answer for a 'major' complication due to its high frequency and clinical significance.

Concept Tested & Keywords

QLH8Abx85XN9VMjtoXMFIq

E6 Medicine Harrison 22e Part 2 p. 304-306

E6 Medicine Davidson Principles Practice 24e p. 444-446