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Dialysis Discussion => Dialysis: Home Dialysis - NxStage Users => Topic started by: tyefly on December 20, 2010, 02:58:15 PM

Title: Heparin usage for nocturnal
Post by: tyefly on December 20, 2010, 02:58:15 PM

  I am starting nocturnal with nxstage......  My clinic doesnt have a clue what to tell me to do so I have been giving them info from everywhere I can find it.....  I will be the first in my area....  Now that they have the pump.... I need t know how much to set the heparin for....how much per hour or what .....  They asked me how long I was planning on doing dialysis and how often......
    I am currently doing 30 L   and I am running 370bfs right now..... I am thinking that  I could do 7.5 hours....???     six days a week.....  they want labs once a week for a month so they can monitor me....   I am thinking that if all looks good maybe I can do 5 days at 40 L.... any thought here.... need some help .....  how much heparin do some of you use....  ???

Title: Re: Heparin usage for nocturnal
Post by: greg10 on December 20, 2010, 05:04:27 PM

This thread may be useful:
according to Rich Berkowitz, he did:
"I've been doing nocturnal sunce June 2008 and wouldn't want to go back. I love the fact I feel so much better, have more energy and certainly have benefitted from the healthy results. The only extra piece of equipment you'll need is a heparin pump. I do a manual bolus of 1000 unites and a continuous drip of 500 every hour until one hour before the end of the treatment. I've been doing 7 1/2 hours and run at 250BFR."

http://www.nxstageusers.com/forum/showthread.php?135-Switching-between-nocturnal-and-short-daily

tyefly, good luck and let us know how it turns out.

Title: Re: Heparin usage for nocturnal
Post by: Bill Peckham on December 20, 2010, 06:53:21 PM

Generally you'll want to give yourself enough heparin so that there is minimal streaking of the artificial kidney at the end and you stop bleeding within 10 minutes. Here are NKC's standing orders - http://nwkidney.org/healthcareProfessionals/nephrologists/hhstanding.pdf (http://nwkidney.org/healthcareProfessionals/nephrologists/hhstanding.pdf)  - your unit will need something like these too (BTW a lot of HHD staff turn to NKC's HHD department for peer to peer support. NKC can be a resource).


The general approach for nocturnal, would be to make a guess based on your current usage. Best to aim low and increase the hourly while monitoring how long it take to stop bleeding. It may mean a few blood cell lost to the process but that's acceptable collateral damage.