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Discussion

heparin dosing

In the acute setting we have used the Lee White method for determining circuit heparinization since before I was employed (Those of you that know what I am talking about can reel your jaw back up). Anyway, the glass tubes are no longer being produced and we now need to come up with a new plan to either hepranize or not. Besides NaCl flushes, what are you doing to determine heparin dosing. We use non reuse dialyzers in the acute setting. Set aside the obvious pre assessment that would negate the use of heparin all together such as recent surgery, GI bleed etc...

Any suggestions would be greatly appreciated

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My first thought is of course to ask the nephrologist. My second thought would be to first try none at all, reassess, and start low with loading dose if that first treatment presents with clotting problems. Quite often during hospitalization the patients are already recieving heparin subq which might allow you to go without. That's been my experience anyway

I work in the acute dialysis setting and have been asked by Consultants to carry out heparin free treatment, either haemodialysis, haemofiltration or haemodiafiltration. It used to be a real nightmare as more often than not we would have to change lines / dialysers due to clotting. We have now changed over to using the AN69 membrane and prime the filter with heparin and not the patient. We have been really impressed so far and now use this dialyser for all of our connvective therapies using either heparin free or a low dose only. We have purchased an ACT machine to minimise heparin when necessary but can usually get away without heparin when we really have to.

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