Heparin Batch Filling

Tish88 · Jun 11, 2012

Where I am currently working, we batch refill the syringes used for heparin infusion.
Question is, if not everything was consumed, for how long should the heparin-NaCl solution be kept before discarding it?

Are you talking about the heparin syringes that are on the dialysis machine, connected to the patients bloodlines?

If this is what you are talking about - you should NOT be keeping this syringe with heparin at all. It should be discarded with the bloodlines. This practice could cause your patients to be susceptible for blood borne pathogens.

Rayden · Jun 11, 2012

Are you talking about the heparin syringes that are on the dialysis machine, connected to the patients bloodlines?
If this is what you are talking about - you should NOT be keeping this syringe with heparin at all. It should be discarded with the bloodlines. This practice could cause your patients to be susceptible for blood borne pathogens.

Sorry I didn't make my question clear.

What I meant was the heparin solution left on the saline bottle after dilution.

Because we dilute the heparin on 500cc saline. (mixture is 1000 units/mL). After aspirating enough 10cc syringes, there's still around 200cc that's left, and most of the time it's just left laying around the medication prep room.

Let's say it was diluted today, will that solution still be potent after 2 days?

Tish88 · Jun 12, 2012

I would say that you would have to make a new batch everyday, since there are no preservatives in Normal Saline bags.

I still am trying to figure out why you are diluting heparin. Is this a cost saving method? Is this for patient infusion during treatments? I have done hemodialysis for over 25 years and I have never seen this done before and I have worked for all the major dialysis companies.

In interventional radiology, we made heparinized saline bags, they had to be made fresh for each patient. The Department of Health does not allow us to use 1 bag for more than 1 patient (infection control reasons), even though these bags NEVER come in contact with any patient. This is a huge waste of NSS since we use liter bags and only use about 200- 300ml per procedure.

Rayden · Jun 12, 2012

How do you anticoagulate your dialysis treatments?

Some of our patients use low molecular weight heparin, but most are on fractioned heparin. That is, heparin diluted in saline to come up with a solution that gives us 1000 units of heparin per 1 cc of the solution.

Prescribed loading dose is usually 2000 units, so that will be 2cc upon initiating treatment. Then the maintaining dose is usually 1000 units per hour, so via the infusion pump, we set it to infuse 1cc of the solution per hour from the 10cc syringe.

As a means to save time, the heparin solutions are batch prepared. We therefore prepare for all 3 shifts the next day, usually 36 patients, so we dilute the 25 vials of heparin in 500cc of saline. But not all of the solution are used, there's around 200cc left from the 500cc bottle. There came a time that several saline bottles left with 100-200cc of heparin solution had piled up in the medication room, as no one would like to aspirate from the old mixtures thinking that it is not potent anymore after several days (and therefore risk clotting a lot of patients).

Tish88 · Jun 13, 2012

We use heparin 1:1000 units per ml and draw this up into 10 ml syringes and put them on the machine. This is for patients that require hourly doses.

We also give our patients bolus' of heparin prior to the start of their treatment (after needles are placed or catheters are accessed).

Once the bolus is given, we wait 4-5 minutes prior to connecting them to the machine to allow for systemic heparinization.

The major of our patients only require a 1 time bolus dose of heparin and no hourly heparin.

Tish88 · Jun 21, 2012

According the the CDC, Normal Saline bags are for single patient use only. These should not be shared.

I think this would include the heparinzed saline bag you are making. This bag can possibly contaminate/infect multiple patients at one time.