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Air Embolism Overridden Alarm Dialysis — ESENeph MCQ

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HardHaemodialysisAir Embolism Overridden Alarm DialysisESENeph

A 50-year-old man on haemodialysis develops acute onset chest tightness, back pain, and hypoxia during dialysis. The dialysis machine shows an air alarm but the nurse overrode it believing it was a false alarm. What has likely occurred?

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Correct answer: D — Venous air embolism – air entered the circuit from a disconnected line or a crack; management: clamp lines, place left lateral head-down (Durant manoeuvre), 100% oxygen, aspirate air from CVC if possible, CPR if arrest

Venous air embolism during dialysis occurs when air enters the venous return line. Even small volumes (50-100 mL) can be fatal. Symptoms include chest pain, dyspnoea, cough, hypoxia, and cardiovascular collapse. Air in the right ventricle creates a foam lock preventing cardiac output. The air detector alarm should NEVER be overridden. Immediate management: clamp the venous line (stop further air entry), Durant manoeuvre (left lateral decubitus, head down – traps air in the right atrium apex away from the pulmonary outflow tract), 100% oxygen (accelerates nitrogen reabsorption), aspire air from CVC if possible, and CPR for cardiac arrest.

Reference: ERA-EDTA 2019 – HD Safety; Resuscitation Council UK – Special Circumstances