Which of the following is a possible cause of increased venous pressure during dialysis?

• A. Hypotension
• B. Low dialysate temperature
• C. Dehydration
• D. Infiltration

Answer: (D)

Increased venous pressure during dialysis signals a problem with venous return through the access site. Infiltration happens when the needle or catheter is not in the vein but in surrounding tissue, so blood cannot flow back freely into the circuit. That resistance to outflow creates backpressure in the venous line, causing the machine to register higher venous pressures and often alarm. You may also see local swelling, tenderness, or hematoma at the cannulation site and sluggish blood flow in the circuit.

Other scenarios—like hypotension, low dialysate temperature, or dehydration—affect overall circulation or patient hemodynamics rather than causing the venous return line to back up in this way. They don’t typically produce the same backpressure in the venous segment of the circuit that infiltration does.

If infiltration is suspected, stop dialysis promptly, remove the needle safely, apply pressure to the site, and establish a new venous access if needed, following protocol and supervisor guidance.