patient has history is of HIT , what kind of the anticoagulant can be used for dialysis

AcuteHD · Oct 1, 2015

Fragmin has an onset time of 1-2 hours and peaks at 4 hours, so it would not be a good candidate for prevention of clotting during dialysis. Saline flushes for that. We use sodium citrate to block catheters in HIT pts. If you are asking if fragmin can be used for DVT prevention if HIT positive, I would think so since they act differently, but that seems like a medical question above my pay grade.

uae808 · Oct 1, 2015

Fragmin has an onset time of 1-2 hours and peaks at 4 hours, so it would not be a good candidate for prevention of clotting during dialysis. Saline flushes for that. We use sodium citrate to block catheters in HIT pts. If you are asking if fragmin can be used for DVT prevention if HIT positive, I would think so since they act differently, but that seems like a medical question above my pay grade.

Thank you for your reply ðŸ˜ðŸ˜ðŸ˜

SmilingBluEyes · Oct 2, 2015

For our HIT patients, we use saline flushes via IV pump to prevent clotting. Most often the rate is at 100 to 200ml per hour and we count that in the UF goal so they are not getting extra fluid. It works like a charm.

AcuteHD · Oct 2, 2015

For our HIT patients, we use saline flushes via IV pump to prevent clotting. Most often the rate is at 100 to 200ml per hour and we count that in the UF goal so they are not getting extra fluid. It works like a charm.

I didn't think a slow, constant flow would be sufficient to clear the dialyzer of clots, I've always done an hourly bolus of 100-200 mL. Using an IV pump would make life a bit easier. I'll have to try that. I assume you are putting it to the arterial med port?

madwife2002, BSN, RN · Oct 3, 2015

I have seen both used with equal results

Chisca, RN · Oct 3, 2015

You could also try priming the circuit with albumin. Albumin is a highly negative charged protein and will adhere to the surface of the tubing in the dialysis circuit helping to reduce contact of blood with the plastic. This contact with a foreign body is what is activating the clotting cascade.

uae808 · Oct 3, 2015

albumin?? how many dose to give and is it expensive??

Our dialysis center use heparin 0.5 mls to coat the fiber of dialyser , we inject 0.5 mls heparin to the A port during recirculating, and drain out the normal saline before connecting patient..

But still need to do NS flushing every 30minutes ..

Chisca, RN · Oct 4, 2015

It's about 250 dollars to prime a circuit with a 250cc 5% albumin solution. As to whether or not it is too expensive it could save you from a clotting circuit and the loss of blood.

AcuteHD · Oct 4, 2015

It's about 250 dollars to prime a circuit with a 250cc 5% albumin solution. As to whether or not it is too expensive it could save you from a clotting circuit and the loss of blood.

That's a lot of money compared to saline or even a new setup. The pt would have to be a fast clotter to justify that.

diabo, RN · Oct 6, 2015

We use a citric acid soluton for the acid portion, Citrsate or Citrapure, in combination with a 50cc bolus q30 min, with the volume added to the goal. These kidneys should NEVER be primed with heparin, I don't care how many times you rinse them. Read up on HITT! It's bad news.

AcuteHD · Oct 6, 2015

forgot about citrasate, we use that also.