title: Blood leak alarm interference by hydoxocobalamin is hemodialysis machine dependent.
abstract: BACKGROUND
  Hydroxocobalamin has been reported to interfere with the blood leak alarm on hemodialysis machines making it difficult to use this treatment modality after hydroxocobalamin infusion.
  
  
  OBJECTIVE
  The objective was to determine if this interference with hydroxocobalamin occurs across hemodialysis machines by different manufacturers. Additionally, we aimed to see if this represented a colorimetric interference alone or if it is the optical properties of hydroxocobalamin.
  
  
  METHODS
  Hydroxocobalamin was reconstituted per package insert. Food coloring was added to 0.9% saline to create the colors of the visual spectrum. Optical properties of absorbance and transmittance were measured. Hydroxocobalamin and the saline solutions were infused into the Fresenius 2008K™ and the Gambro Phoenix X36™ machines. Times were recorded from the start of the machine until the solution finished or the alarm triggered.
  
  
  RESULTS
  When evaluating the Gambro Phoenix X36™ machine and dialysis circuit; the alarm did not trigger. In contrast, the blood leak alarm on the Fresenius 2008K™ machine was tripped by both the red solution and hydoxocobalamin infused per the package insert. The alarm stopped the machine between 128 and 132 seconds for the red solution and between 30 and 35 seconds with the hydroxocobalamin. Membranes of the circuits where the alarm tripped were examined and remained intact without blood. Results were validated on different machines with new circuits.
  
  
  CONCLUSIONS
  Hydroxocobalamin infusion per package insert and the red saline solution prepared with Red Dye 40 both triggered the blood leak alarm and stopped the Fresenius 2008K™ machine. However, this was not true for the Gambro Phoenix X36™ machine as the alarm never triggered. The interference with the Fresenius 2008K™ appears colorimetric due to normal saline with Red Dye 40 triggering the alarm.
  
  
  CONCLUSIONS
  We alert physicians to become familiar with the properties of individual dialysis machines prior to use of hydroxocobalamin. When facing difficulties with hemodialysis after the administration of hydroxocobalamin, consider attempting with a different manufactures machine or model if available or contact the manufacturer directly.
authors.affiliation: Department of Emergency Medicine, School of Medicine, University of California, Davis, CA 95616, USA. Mark.sutter@ucdmc.ucdavis.edu
authors.forename: M E
authors.initials: ME
authors.lastname: Sutter
authors.forename: M E
authors.initials: ME
authors.lastname: Clarke
authors.forename: J
authors.initials: J
authors.lastname: Cobb
authors.forename: G P
authors.initials: GP
authors.lastname: Daubert
authors.forename: V S
authors.initials: VS
authors.lastname: Rathore
authors.forename: L S
authors.initials: LS
authors.lastname: Aston
authors.forename: R H
authors.initials: RH
authors.lastname: Poppenga
authors.forename: J B
authors.initials: JB
authors.lastname: Ford
authors.forename: K P
authors.initials: KP
authors.lastname: Owen
authors.forename: T E
authors.initials: TE
authors.lastname: Albertson
mesh_terms: D056902:Clinical Alarms; D003116:Color; D003951:Diagnostic Errors; D005189:False Positive Reactions; D006417:Hematuria / Q000175:diagnosis; D006801:Humans; D006879:Hydroxocobalamin / Q000737:chemistry*; D008991:Monitoring, Physiologic / Q000379:methods*; D061214:Patient Safety; D006435:Renal Dialysis / Q000295:instrumentation*
chemical_list: D006879:Hydroxocobalamin