Intradialytic Heparin Reduction & Validation of Extracorporeal Circuit Subjective Clotting Scale Study

Abstract

Unfractionated heparin (UFH) use during dialysis has a narrow therapeutic window; if misjudged the dose administered by nurses based on visual assessment of post dialysis clotting and hemostasis time can cause adverse bleeding or ill effects in these patients. The purpose of this MN thesis prospective study was to examine the efficacy of a new heparin protocol. Specific research questions included: 1) Will the use of a more aggressive heparin-reduction protocol reduce the cumulative heparin dosage in chronic hemodialysis (HD) patients, 2) Is there a relationship between the dialyzer clotting scale and the ultrasound based FBV measurement, and 3) Is the visual dialyzer clotting scale used for the study reliable? Use of the study protocol significantly reduced cumulative heparin dose (p=<0.001); without affecting KT/V (F(5,55)=1.67, p=.157) or leading to extracorporeal circuit loss. Inter-rater reliability was evident between study nurse dialyzer scores (p=0.688) but there was no intra-rater reliability between study nurse and or clinical nurse educator/hemodialysis nurses.