Timing on Heparin Bolus

[Wallyz]

Hi, I'm a nxStage user in Lake Steves, WA.  due to a reaction to heparin, I have been giving my heparin bolun in the line after the pump starts. i just heard via my nurse that there may be  aproblem with the effectiveness of the dialysis by letting the blood hit the filter  before the heparin. anyone know any resources or studies about this?

[silverhead]

What line are you putting it in? how much Heparin in the dose?
Our normal procedure is to have 3500 units in a 10ml syringe and after putting in the venous and arterial needles I  bring the blood to the end of the venous line then hook the syringe to it and pull the blood in and out twice to mix it  remove the empty syringe and then push a full 10ml syringe of saline through it, then do the normal hook up of the arterial line and begin treatment for the day.

[flip]

Ours is very similar only we get 2500 initially and another 1000 after 2 hours.

[Wallyz]

I started out doing the same, but because of a bad reaction, I started putting it in the blue clamped port (priming port) at the outflow (up) side of the filter.


I use 6000, with a 2000 bolus after 1 hour.  (118 kg, 33yrs, I clot really fast )

I am going extended, but the issue is the blood hitting the filter before the heparin.   Has anyone else heard anything about this issue?

[flip]

I know some people who can't use heparin. They do a saline rinse before starting the blood.

[jbeany]

I haven't heard anything about it - but then I'm doing a similar procedure to silverhead - only I mix blood a heparin in the syringe more, about 6 times, and don't do a saline flush.  Can't you inject the heparin immediately after starting the pump?  It takes a minute or so for the blood to flow thru the tubes and reach the filter- that ought to be enough time to inject the heparin - especially if you attach the heparin syringe before you start the pump.  Just leave the blue clamp closed until you hit the green kidney button.

[Wallyz]

I haven't heard anything about it - but then I'm doing a similar procedure to silverhead - only I mix blood a heparin in the syringe more, about 6 times, and don't do a saline flush.  Can't you inject the heparin immediately after starting the pump?  It takes a minute or so for the blood to flow thru the tubes and reach the filter- that ought to be enough time to inject the heparin - especially if you attach the heparin syringe before you start the pump.  Just leave the blue clamp closed until you hit the green kidney button.

The blood would still hit the filter before the heparin in that case.  The blue clamp is on the outflow side, and it would be pushed towards me and away from the filter.

I am able to use the heparin as long as I don't inject it directly into my system as in the standard process.  The theory as presented to me is that the when initial contact with the filter is made, the fibrin coats the filter and  thus lowers your usable filter area. This is more a technical/ biology issue, and I am looking for any one with that kind of expertise.

[Roadrunner]

Wallzy,
My husband doesn't use heparin.  Does this mean he isn't being dialysized as well?

[flip]

My nurse today told me that if the blood hit the membrane before the heparin, there was a greater chance of clotting.

[Wallyz]

Wallzy,
My husband doesn't use heparin.  Does this mean he isn't being dialysized as well?

That's the idea.  I'm looking for verification of that theory

Flip- I understand that as well, I'm just trying to see if there is significant degradation in the quality of dialysis.   Looks like a science project for my kids;)

[flip]

I know they use a different acid solution for those who can't take heparin. I don't that heparin,or lack of it would affect the quality of dialysis as long as there is sufficient flow and the dialyzer doesn't clot.

[Wallyz]

Here is the latest on this issue-

Without heparin, you do have a reduced surface area to dialyse. It is not really that significant, unless you are near you limits anyways.  So- if you use heparin, make sure it hits the filter before the blood. (or mixed withthe first blood that hit s the filter)  If you don't  use heparin, you will be dialysing longer (more L of dialysate) for the same quality of dialysis.