Normal saline rinses: yes or no

Specialties Urology

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Hi, I work in acute unit, therefore have many pts come in overloaded, some of these post procedure can't have heparin and are ordered for NS rinses. The majority of nurses i work with and many I have talked to believe that NS rinses don't do anything to stop a system from clotting, it only makes it hard to get fluid off because your putting so much in. If NS rinses just show you wheter or not a system is clotting, why cant you just rely on the pressure readings? If anybody has any studies or literature on this as well, i would appreciate it. otherwise, please give me your thoughts. thanks:idea:

We've tried everything that we can do without a doc's order. Today the doc came around and lowered his Epo dose, since his Hgb was extremely high. Doc said hopefully that would help some...although I have my doubts as to how much that will help. Today the pt clotted off his line yet again. It's been just over 2 weeks since he had a full tx, so we're all extremely concerned. We're going to try a continual saline drip into the venous chamber on Wednesday. Hopefully that will help solve some of the clotting issues.

I believe that EPO can "cause" clotting. Especially if they are getting too much..

I'll research it and get back to ya.

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What do you mean "heparenis" your dialyzer??? I was working with machines that had a heparin pump and we would give 2-3ml bolus of heparin at the beginning before pt was put on then they got 1-2ml an hour during the tx. Now I am working at a different company and they give heparin bolus up front IVP via the access. I have been having trouble with my lines clotting even though I am giving NS bolus.

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What do you mean "heparenis" your dialyzer??? I was working with machines that had a heparin pump and we would give 2-3ml bolus of heparin at the beginning before pt was put on then they got 1-2ml an hour during the tx. Now I am working at a different company and they give heparin bolus up front IVP via the access. I have been having trouble with my lines clotting even though I am giving NS bolus.

When you prime the dialyzer many Davita and some Fresenius unit add 1000 units of heparin to the system. Supposedly coats the fibers of the dialyzer.. I don't know if it works or not..

I've done it both ways.

Are you and the OP using reused dialyzers or all non reuse?

Usually in acutes it's non re-use.

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Thanks for replying to my question. I work in Acute Dialysis. We use dry packs all the time. I worked for Davita and now work for Freesinus I was taught by Freesinus to give heparin up front via the access, well this doesn't seem to do the trick my patients still clot off at the end of the treatment. I think maybe I still have a few things to learn about Freesinus machines.

Thanks,

jilpil3

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Thanks for replying to my question. I work in Acute Dialysis. We use dry packs all the time. I worked for Davita and now work for Freesinus I was taught by Freesinus to give heparin up front via the access, well this doesn't seem to do the trick my patients still clot off at the end of the treatment. I think maybe I still have a few things to learn about Freesinus machines.

Thanks,

jilpil3

Have you tried heparinizing your dialyzer as I suggeted in a previous post.

If you don't want to use an extra 1000 units then use a 1000 units from the bolus dose.

Are you using the heparin pump to deliver low doses through out the treatment.

What are you running your blood pump at? 400??

Are you using a cath and does it need activase so you can get a decent blood pump flow?

What machines were you using at Davita. Every Davita unit I've worked in have used Fresenius either the H or K...

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Well, it worked! We used a NS rinse on our pt...1000cc bag with 10cc of heparin mixed in. Put it on a pump and ran it directly into the venous chamber at 200cc/hr. He ran his whole tx and his dializer (and the lines) had no clots at all by the end of the tx. :)

Doc d/c'd the epo since his Hgb was way up there and he raised his base weight.

btw...we run Braun machines.

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Well, it worked! We used a NS rinse on our pt...1000cc bag with 10cc of heparin mixed in. Put it on a pump and ran it directly into the venous chamber at 200cc/hr. He ran his whole tx and his dializer (and the lines) had no clots at all by the end of the tx. :)

Doc d/c'd the epo since his Hgb was way up there and he raised his base weight.

btw...we run Braun machines.

Well I'm glad it worked, I have a feeling it's the EPO though. Although on second thought I think EPO would take a few days to get out of the system. So maybe it is the Heparin..

Good luck ..Don't forget this hint..LOLL And remember Doc's really don't know much about dialysis..LOL The process I mean.. I had one ask me if UF profiling was the same as NA modeling..LOLL

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Good luck ..Don't forget this hint..LOLL And remember Doc's really don't know much about dialysis..LOL The process I mean.. I had one ask me if UF profiling was the same as NA modeling..LOLL

I've noticed this myself! Scary stuff! For example...why would a doc even THINK about having a 94 y/o pt get a AVF? Or a pt who is due to get a transplant in 2.5 months (live donor)? Good lord. I know it's this whole "Fistula First" campaign that we're doing, but come on! :banghead:

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I've noticed this myself! Scary stuff! For example...why would a doc even THINK about having a 94 y/o pt get a AVF? Or a pt who is due to get a transplant in 2.5 months (live donor)? Good lord. I know it's this whole "Fistula First" campaign that we're doing, but come on! :banghead:

It is fistula first but also a potential transplant patient needs to be in opitimal health and a fistula gives the best dialysis.

They 94 year old is at much greater risk of infection with a catheter and is probably very fragile. Their system won't tolerate an infection as easily as a younger patient.

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:) I appeciate all the above responses, but, can anyone tell me HOW NS stops people from clotting? Thanks

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:) I appeciate all the above responses, but, can anyone tell me HOW NS stops people from clotting? Thanks

It doesn't stop clotting. It dilutes the blood, changes the viscosity and helps with the flow of blood through the lines . It slows the potential for clotting. Even with NS flushes you can still see clots in either or chamber. Just smaller or less. Sometimes none. Depends on the patients clotting times. One thing to remember. Air in the system will cause clotting just as air on a cut causes clotting. If you have air in your system from a dry bag you are more likely to have clotting of the system.

Also, similiar to a running river not freezing, running thin blood won't clot.

And I suppose the thinness, similiar to taking asa or plavix, interrupts the clotting casacade.

These are just educated guesses. I suppose you'd have to ask a physologist for the real deal.

Somethings just work we don't always know the how or why.

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we routinely flush with 100ml NS every 30 min. In my 10 years experience, I have found that giving the NS prime-which most places now do, and getting BFR up to 350-400 is what works best for keeping systems open. Depending on patient stability, I do also add 0.1L to TL when flushing rather than all at beginning.

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