Question: Surgery with dialysis and heparin

[RightSide]

On Monday 29 December, I had a trans-urethral resection of my prostate (TURP) surgery performed.  There was some post-op bleeding when I urinated, as is normal with this type of surgery.  My surgeon assured me that the bleeding would stop fairly soon.

But the bleeding hasn't stopped yet.  In fact, when I came home after today's HD session at my dialysis center, the bleeding suddenly got much worse all over again.

I'm wondering if the heparin they give me after HD could be the cause?  I asked the nurses not to give me any heparin during the dialysis (just do saline flushes of the equipment).  But they told me that they still have to inject heparin into my HD catheter at the end of each session to keep the catheter from clotting.  (I don't have a fistula yet.)

If heparin during or after dialysis exacerbates post-operative bleeding, then how can you have many surgical procedures safely without excessive post-op bleeding?  Is there any way around this?

[monrein]

Ask if they can use citrate.

[nursewratchet]

Any surgery scheduled, should have heparin held the day prior, and the day after, or as long as your actively still bleeding.  this only refers to the treatment heparin.  Catheter "packing" of the heaprin is different alltogether.  The ports on your catheter are measured in length.  It will say for example 1.3, or 1.4, whatever the length is.  That is the amount of heparin that goes in there.  That ensures that the heparin is only enough cc's that it runs the length of the catheter.  None can get into the blood system, there is a valve in the catheter to prevent that.  That heparin is a different dose than the pre treatment heparin, and is not suitable for total body heparin.  It always gets aspirated before the next treatmnet.  If you are taking any Coumadin, Asparin, Motrin or Prednisone, that could prolong your bleeding.  Hope this helps. 

[AlasdairUK]

Hiya,

It's not that uncommon to have a little bleeding for a bit after an op. What you need to look out for is the amount of bleeding, if you feel that it is increasing, then go and have it looked at.

Heparin that is used in dialysis breaks down quickly in the blood stream and it should not have a long lasting effect. If you do have any concerns, consult your doctors as the last thing you need, is to lose blood and have your haemoglobin levels drop.

Alasdair

[paddbear0000]

Man, NurseW, I am soooo glad you are here!  It is so nice to get answers to our questions!   

[kitkatz]

I agree. It is nice to have a friendly person to answer some of our medical questions.

[boxman55]

Great explanation NurseWR...Boxman

[RightSide]

Yes!  Thank you for that explanation, NurseW!

The extra bleeding I experienced could be a coincidence.  I forgot that I have also been constipated lately, and I've done my share of straining on the toilet to get a bowel movement.  That is probably putting pressure on the prostate, which may cause it to bleed a bit after the TURP surgery.