Heparin

[SweetyPie]

I will be stopping heparin for 2 week because of my wisdom tootb surgery. Anyone ever tried this? Will the dialysis machine beep every second?

[Simon Dog]

I ran without heparin for years, no problems.  But then, I had low platelets.  Try flushing the filter every 30 minutes or so (just add the flush volume to your goal)

[Riki]

Try flushing the filter every 30 minutes or so (just add the flush volume to your goal)

That's what the nurses do here when someone needs their heparin stopped (though, technically, we don't even use heparin anymore, we have something called frag that is used instead).  The new machines we have can be programmed to do the flushes, so they just have to add that to the goal.

[SweetyPie]

I was supposed to stop heparin on Tuesday but techs forgot. Today I come in and the nurse says the doctor said to slow decrease the heparin don’t stop it because I will clot. I am stressful I do NOT want to bleed excessively after surgery. If I do not form a blood clot it’s more problems for my teeth and I will develop dry socket which I’m terrified of. How long does it take for heparin to leave your body? My surgery is Wednesday:(

[Michael Murphy]

I have been told by my nephrologist and cardiologist that for all intents after 4 hours the effects of heparin are gone in 4 hours.

[rcjordan]

>4 hours

I'm on 5 ml per session. I was told the same but they change their tune when the needle sites still bleed after 16 hours.

[Simon Dog]

Heparin dosage is expressed in units, not ML, as there are multiple concentrations available.    Any sane dialysis clinic will only have one concentration as the difference in concentration can be a factor of ten.

As to "you will clot" - ask the neph if (s)he is referring to clotting in the dialysis filter, your body, or both.

Heparin does have a short half life, which is why nocturnal dialysis patients are offered delivered heparin via an infusion pump rather than a single bolus at the start of treatment

[Cowdog]

I'm on a 4 unit bolus and 2 units per hour maintenance. As mentioned the half life is about 4 hours. If I don't get Heparin my machine will clot up to the point of not running in a about 2 hours.

[Simon Dog]

I'm on a 4 unit bolus and 2 units per hour maintenance.

I doubt that     A typical bolus would be 4000 units, not 4.  At a 1000 unit/cc concentration heparin, it would be a 4cc dose, not a 4 unit dose.

[rcjordan]

I'm on the 1000 usp units per ml concentration. My HHD clinic set me up on a 5 ml dose administered through the permcath at the beginning of the 2.5 hr session. That seems to work ok for me.

HALF life makes much more sense than what we're initially told about "fast dissipating" or "gone in 4 hours."  Other factors may be involved, of course, but since ESRD I've gone from super-fast clotter to easy-bleeder.   Clinic says they'll likely cut my heparin dose by half once I'm able to use the fistula.

[GA_DAWG]

I had oral surgery where they removed most of my teeth and only went without heparin for the session immediately following the surgery. They have always told me the machine takes out the heparin by the end of that session. If they do decide to take you off of it for a period, they should rinse you every 30 minutes, as noted, and then they will add the amount of rinse to your goal.

[SweetyPie]

I feel a bit relieved that heparin doesnt stay in the body for long. Flushing every 30 min sounds a lot

[Michael Murphy]

After twice suffering large hemorrhage in my eyes I have been  taking off heparin both bleeds occurred during dialysis, since then mostly they rely on the warfarin, placid, aspirin I take daily to avoid clotting.  I clotted two treatments ago and it was the first time in a year.

[Cowdog]

I'm on a 4 unit bolus and 2 units per hour maintenance. As mentioned the half life is about 4 hours. If I don't get Heparin my machine will clot up to the point of not running in a about 2 hours.

You are correct it's 4000  units bolus and 2000 units/hr maintenance!

[Alexysis]

I went without Heparin for an entire month, but on the 4th week the dialyzer clotted twice, so I went back on a reduced heparin schedule.

[Riki]

After twice suffering large hemorrhage in my eyes I have been  taking off heparin both bleeds occurred during dialysis, since then mostly they rely on the warfarin, placid, aspirin I take daily to avoid clotting.  I clotted two treatments ago and it was the first time in a year.

A fellow in my unit had that happen.  He lost sight in one of his eyes afterwards.  He had to have some kind of surgery to save the sight in his other eye.  I don't remember all the details, though he did explain it to me. *G*  He is on warfarin and they check his level (INR?) twice a week and adjust accordingly.  Since we don't use heparin in our unit anymore, I'm not sure what he does.  He's moved to a different shift, so I haven't talked to him in a bit.

[GA_DAWG]

The worst I had happen was when we were shifting from my catheter to my graft. They still changed the dressing, and I assume put heparin into it to prevent it from clotting, but I was also getting it through the graft. At any rate, I got way too much and it wiped out completely the clotting agent in my blood. After a couple of hours of it not clotting, I was taken to the ER, and blood tests showed the reason. Every place on my body that had even a small cut or scratch was bleeding. The vascular/ transplant surgeon at the hospital was not amused though he said it was not the first time. They gave me an IV that contained the required clotting agent, though the nurse had to sitt right by the bed and told me if anything felt strange let her know immediately, because any reaction would be deadly very quickly. Luckily nothing happened and a couple hours later, I got to go home.

[SweetyPie]

I had just gotten and new cath after an infection. After I recived dialysis the site kept bleeding and wouldn't clot! It was tough to clean plus it was painful because it was brand new. They put a whole lot of gauze on it and a dew hours later you can still see blood seeping through. Thinking about this makes my legs weak! So im sure you can understand why I am freaking out about this whole situation.

[Simon Dog]

A fellow in my unit had that happen.  He lost sight in one of his eyes afterward.

I have some ultra small retinal bleeds.  The local, as well as the hotshot retina guy in Boston, says no medical intervention needed.   That motivated me to try D without heparin (it worked!).

[GA_DAWG]

It works, but is a lot more work for the techs, and the added water from rinsing has to be added to your total each time.

[cassandra]

It works, but is a lot more work for the techs, and the added water from rinsing has to be added to your total each time.

But it's okay to add the extra liquid to the UF per hour rate. So time doesn't need to be increased 

[Simon Dog]

Added "each time" does not mean "added time". 

[SweetyPie]

One concern and I’m freaking out,
I just remember pain meds get washed out during dialysis. I am getting surgery tomorrow! What will I do during dialysis? Sit there on agony? This is awful

[cassandra]

One concern and I’m freaking out,
I just remember pain meds get washed out during dialysis. I am getting surgery tomorrow! What will I do during dialysis? Sit there on agony? This is awful

Take whichever pain meds the dentist gives you with you. Take it during D when you start to feel any pain.


Good luck tomorrow, Cas

[GA_DAWG]

I was lucky and did not need pain meds after surgery, so I can't answer that one. They don't add time, just fluid, that they then up the goal to remove. Hope everything goes well for you.