Blood clots and Heperin!

[lillinny]

Wondering if anyone can clue me in. . . . Found some clots about 6 weeks ago and doc upped the Heperan.  Last night after D noticed that the arterial line going into the filter had a good size clot.  Told Rn who is going to call Doc.  Anyone have any thoughts on what a 'normal' Heperan does is?  Husband is at 7 units now.  Started at 5.  Also, how normal is finding clots going into the filter?

And lastly, how concerned should I be?

[vcarmody]

We use 4000 units of heparin put right into his venous line after I insert it.  I think everyone does it different.  I always notice clots in the pressure pod and the filter after rinse back but never anywhere else.  I was told clotting is bad.  When they noticed clotting they upped my husband heparin he started at 2000 units then went up to 3000 now he is at 4000.  Wish I had better answers for you. 

[lillinny]

Thank you. . . glad to hear you still notice clots in the lines.  Wasn't sure how freaked out we should be!   
Still waiting to hear from neph but while we don't want clots, we don't want him to not be able to clot at the end of tx because of high heperin either!! 

[silverhead]

We experienced the clots in the POD and the inlet to the filter for a long time, our solution was the split up the dose, I gave her 3300 in the venous line at the beginning and half way through the session gave her another 2300 through the port at the top of the filter, (We were doing 4 hour sessions) it cleared up the clotting completely.
One lesson I learned was when putting in the dose at the half way point was to put it in very slowly, otherwise the air detector sees the thinned blood as "air" and will alarm. I used a 3ML syringe and put in a liitle Heparin and then drawed back some blood a few times to mix it in good.
Anyway, her dose of 5600 worked well for her, I tried many times to lower the dose and always experienced clotting if I did so.......

[Bruno]

Excessive clotting could mean you need to reduce your aranesp. Too much haemoglobin can be a problem. We tried it two ways with heparin...a booster shot into the line when starting up and regular shots every hour. We also tried mixing it with saline and shooting it into the cannula immediately after we gained access.
You need to be careful with the stuff as you would know and give it time to clear your system before dialysis end, so your last dose is as important as your first.

[donster]

We use 6000 units of heparin split into two doses; one at initial cannulation/flush and the other given 90 minutes later. Our current tx takes right around 3 hours. There is usually only very slight red stripe clotting visible in the filter (kidney) after washback.

[Bruno]

I didn't really help much previously...it's true you need to watch clotting with too much Aranesp as a possible cause, but that really didn't answer your question. I use heparin as follows...2000 into the line as soon as I connect up, then 1300 every hour into the line with the final shot one hour before you finish.
So a 5 hour session would be 2000+3x1330=3990...5990 in total.
I'm not sure that if you already have clots causing poor access during cannulation that heparin helps...when that happened to me we had to wait for the body to clear the clot...which it eventually did.