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

[uae808]

Hi , fellows ,

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

Most our patients use fragmin , can use fragmin for HIT patient?

[uae808]

No ,Diabo, what I mean is to use heparin coat for non-HIT patient , but need fragmin free HD in our center , we never use heparin for HIT patient!

[SmilingBluEyes]

We run our saline pumps at 200ml/hr for most. As little as 100ml/hr works. It works MUCH MUCH better than flushing, as it's constant. And actually, we use the venous port most of the time, with EXCELLENT results.

[SmilingBluEyes]

Citrasate has been used in our clinic but RARELY. It's always about money $$$$ and saline is cheap.

[AcuteHD]

...and actually, we use the venous port most of the time, with EXCELLENT results.

I believe you, but...

[diabo, RN]

In our 20 chair. 100 or so patients, chronic unit (hospital owned) we use Citrapure only, delivered into the bulk tank. Many patient's don't even require heparin. We still use jugs here in acute.

[uae808]

citrpure stand for citrate calcium ?

[uae808]

sorry ,citrapure

[diabo, RN]

Much cheaper than Citrasate

http://www.rockwellmed.com/Collateral/Documents/English-US/CitraPureRevised.pdf

[SmilingBluEyes]

No AcuteHD I am not kidding. And it works.

[Chimera123, BSN]

We only use Citrapure regardless if the pt has HIT or not. For HIT pt, we flush the the line every half an hour.

[MizChelleRN]

I've used a continuous infusion to prevent clotting before too. I've seen it hooked to both arterial or venous lines. I prefer hooking to the venous line, bc I figure art line clotting is less likely bc it's so close to the patient. Hooking it to the venous line keeps that venous drip chamber watery, diluted. But it won't stop a clotted dialyzer.

Actually I prefer a good hard manual flush so you can evaluate how thick the drip chambers and dialyzer headers are getting. But for time issues, I like the infusion flushes. Plus the patient will not overfiltrate if the manual flushes get missed.

Oooooh so that raises this question: do you set your goal pretreatment to include the 1500 cc of saline you intend to give, or do you add 200 to the goal every time you give a 200 flush?

[NurseRies, BSN, RN]

I've never been too convinced that flushing prevents clotting. I am open to the idea and I have seen it done here and there, but how are people saying it works? How do you know that they would have clotted without the saline flushes? I personally never add flushes unless the doctor wants it and I rarely have clotting problems. Our docs rarely order heparin on anyone in the hospital. I tend to think people will either clot or they won't. If they have HIT, are their platelets less then 100? Are they really likely to clot? Are they fluid overloaded and now we have to add 300-800 more cc to the goal and bolus them with saline? That sounds like a lot of sodium for folks on a sodium restricted diet. Other then patients who have a history of clotting, the only thing I think that increases the risk, is frequent and constant alarms on the machine. I also think catching signs of clotting before the dialyzer clots is easy and completely doable. Do we really have to have some form of anticoagulant on everyone? I run patients with no heparin everyday and rarely have problems..

Thanks for the input. This has been a controversy for me personally, no one on my team routinely flushes with saline.