Heparin Practices

[Ashley_SF, BSN]

I would like some input from my dialysis nurses, both acute and outpatient regarding the use of heparin where they work. I recently transitioned from outpatient, adult, dialysis to outpatient pediatric/inpatient pediatric/inpatient adult dialysis and am confused by heparin policies at my new place of employment.

The adult acutes hospital (does not contract their dialysis out) I am working at does not use heparin period during dialysis to prevent clotting in the extra corporeal circuit. On the pediatric side, which is owned by the same hospital but at a different location, we do use heparin.

The 40+ years nurse I worked with yesterday told me they don't find heparin or regular saline flushes necessary and it is a liability for the acute adult population we work with..

I've worked in outpatient dialysis for 5 years and have operated under the belief that heparin is needed for most patients during dialysis. I have many patients who develop clots in the arterial chambers/dialyzers if their heparin is missed..

I would appreciate any input, especially from the very experienced nurses.

Thank you!

[nossawja, BSN, RN]

Did she say why it was a liability for the population you work with?

Do you use heparin to keep CVCs patent?

I've worked in acute dialysis and the docs prescribed heparin just like in the outpatient unit. Heparin has a fairly short half life, so mostly by the time a hemo treatment is over, the heparin has metabolized out. That confuses me....

[Ashley_SF, BSN]

She was saying that the acute patients are more fragile than in the outpatient units, especially in the ICU, because of low platelets, other anticoagulant therapy etc.

But, that was my thought exactly about the short half life of heparin, that's why we use that particular drug.

I'm going to talk to my manager on the pediatric side next week because we use heparin with both out adult and pediatric patients at our other campus. The other odd thing is that we have a general supervisor who oversees all of the dialysis units within our hospital system, so you would think we would all have the same policy.

We use sodium citrate to keep the CVCs patent.

[integrativenurse]

Acute doctors don't immediately prescribe heparin even if the patients were getting heparin in their home clinics. Diagnosis, labs, current meds, and extenuating circumstances will dictate if heparin should be resumed or initiated.

[Spinmass, ADN, BSN, RN, EMT-B]

When I transitioned from OP to IP dialysis, I was also befuddled by the lack of heparin orders. Four years later and I have had very few times that it would have been beneficial. In those instances, I am able to flush the system, add to the goal and continue without issue. Now I am of the opinion that we actually over heparinize patients in the OP setting in order to reduce alarms and avoid constant monitoring of the system. Don't get me wrong, it makes sense to avoid losing systems from both a patient safety and cost standpoint. We do typically lock our CVC's with heparin, although we are slowly transitioning to tegos end caps and saline locks.