Reversed Catheter Lines Recirculation — ESENeph MCQ

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ModerateHaemodialysisReversed Catheter Lines RecirculationESENeph

A 55-year-old man with CKD G5D on HD has a tunnelled catheter. His dialysis nurse notes that the arterial and venous lumens are labelled 'A' (red) and 'V' (blue). During a session, the nurse accidentally connects them in reverse (arterial to venous port and vice versa). What is the clinical consequence?

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Correct answer: A — Reversed line connection causes increased access recirculation (15-30% vs normal <5%), dramatically reducing dialysis efficiency (effective Kt/V drops significantly); there is no immediate safety hazard but the session provides inadequate dialysis

Reversed catheter connections (arterial needle/line connected to the venous lumen and vice versa) cause significant recirculation: already-dialysed blood from the venous return immediately re-enters the arterial intake. This can increase recirculation to 15-30% (vs normal <5%), substantially reducing effective solute clearance. It is not immediately dangerous but renders the dialysis session inadequate. The reduced Kt/V means uraemic toxins are not effectively removed. Modern dialysis machines may detect the altered pressure patterns. If discovered during a session, lines should be reconnected correctly and session time extended.

Reference: UKKA 2019 – VA; ERA-EDTA 2019 – HD Safety