dialyzer streaking

[LPN2RNBSN]

What are policies of other units when there is streaking in dialyzer after treatments?

[DeLana_RN, BSN, RN]

Clotting of fibers in the dialyzer usually indicates that not enough heparin was used during the tx. Or, if heparin is not advised, that the dialyzer was not regularly flushed with saline during dialysis. Often, it is not a problem (such as in an acute setting where reuse is not practiced).

In general, however, you would want to increase the pt's routine heparin dose. Your clinic may have protocols by how much the RN can adjust the dose; or, you may need to call the nephrologist. In the clinic where I worked, we would increase the loading and/or maintenance (hourly) heparin dose per protocol, but at the RN's discretion (e.g., from 2000U to 4000U); the nephrologist would then sign off on the order.

Your manager or charge nurse should give you guidance. Especially in a reuse unit, they would be happy to hear that you noticed this.

DeLana :)

[LPN2RNBSN]

Thank you. I was clearly told it was not a problem for the dialyzer to streak. I am beginning to wonder about the information I am given. In reading, I know that much of what I am told is not correct. Disgusted.

[DeLana_RN, BSN, RN]

Thank you. I was clearly told it was not a problem for the dialyzer to streak. I am beginning to wonder about the information I am given. In reading, I know that much of what I am told is not correct. Disgusted.

Of course, I don't know who told you, but I have found in 5+ years of working outpatient dialysis that there are some nurses who would rather not be bothered with doing their job - well, let me rephrase, all aspects of their job (such as making heparin adjustments or bringing the need to do so to the physician's attention). Perhaps your preceptor (if you're new) or charge nurse is one of those?

DeLana

P.S. Some people think that clotted fibers in the dialyzer are not a problem because it's either non-reuse (and they'll throw it away) or, if they do reuse, the dialyzer passes many times. In my book, it's still a problem if there is clotting each tx.

[LPN2RNBSN]

Our unit uses single use. It was the RN who told me not a problem, but it was the tech who said it was a problem but then would not stand up tot he RN...

[DeLana_RN, BSN, RN]

Our unit uses single use. It was the RN who told me not a problem, but it was the tech who said it was a problem but then would not stand up tot he RN...

The tech probably knew that the RN would not listen to his/her opinion.

If you're an orientee or student, there is little (if anything) your can do; but if you decide to work in dialysis, you most certainly can.

Good luck!

DeLana