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We use very little heparin as well due to all the same issues mentioned here. What has worked for us is a 200mL NSS flush at 15 minutes into the treatment. This knocks the platelets off the fibers that stick on in the beginning of the treatment. It is important not to wait longer than 15 minutes, or it will not work. This is the only flush that is needed. I am not a fan of continuous flushes, especially considering the many patients with cardiac issues. The "15 minute platelet flush" as we have come to call it, has been very successful. However, if your patient has access flow issues or is septic, you will have clotting issues. I have never personally worked with citrasate, Hope this helps!

Hi Janice,
I've had the experience of using heparin regimens that run the gammet from 0 heparin to systemic heparin. Most recently the hospital that I work at has gone to a no heparin prescription and the treatments run 4 hrs to 8hr. SLED. I've found that flushing the system with 100ml NS every 30mins or 200 ml every hr has worked wonders in preventing clotting in most cases. I was initially concerned about the SLED patients because of the slow low flows, but have found that the NS flushes are working well. I've used Citrasate baths in the past as well, however in my current work setting it would be very cost prohibited. Another important factor that I find is that clearing the dialyzer of any particles by priming it with 1000 ml of NS pre dialysis helps. Some manufacturers recommend this depending upon the dialyzer you are using. Currently I am using the Opti-fluxs. Hope this helps.

Hello Janice,
I have done acute dialysis previously with a contractt program that served numerous hospital and now at a community hospital. We use very little heparin, because of HIT , post op etc. Usually 1000 units. I agree pump speed and access seem to be the big determining factor, Normal saline flushes don't seem effective one way or the other. For hypercoagualbe patients and patients with HIT, we have recently had very good results with the Citrasate dialsysate with no associated calcium problems on a small population of patients. . It costs about 3-4 time what your standared acid would cost, but when you calculate the costs of reset ups with a new dialyzer , nurse hours of extended treatments, loss of blood, and just the over all frustion level it is a wash to my budget. Cathy Grant

Hi Janice,
On our standing orders we give 1000unit intial dose then 500units and hour stop 1/2 before take off. If heparin free NS flushes 200ml every 1/2 hour and we also use citrsate dialysate.Let me know if you nedd more info.
Sue Fallone

At our hospital, the physician are very particular with heparin use because of HIT. If they want prime, we instill heparin of 5000 units to recirculate in the machine and dump it before we start the treatment. Then if they want tight, we give 1000 unit to the system or arterial chamber of the gambro machine upon the start of dialysis. The sales representative has recently been introducing a high influx dialyzer cell that will address or lessen the clotting incidence. It is nice to see if this true untill we finished our present supply.

Hello,
I am an agency nurse and work several different Dialysis facilities in acute care.Private as well as a large teaching hospital.The policy was recently re-written by both places I will be happy to forward to you. I find it very interesting that at the private hospital little to no heparin is given including circulation and dump for the machine set up. While at the teaching hospital the Medical director is very pro-heparin.He believes in C&D for the machines and a large bolus with heparin pump for most everyone. Yet I see no difference in the clotting issues between the two hospitals Access patency and pump rate are the only factors in clotting systems.