DEFINITION
Heparin is an anti-coagulant used to prevent platelet aggregation in order to maintain the extra corporeal circuit. It inhibits the generation and activity of thrombin (Factor 11a).
PURPOSE
1. Heparin is used routinely to anti-coagulate the blood during heamodialysis.
CONDITIONS
1. Applies to all Registered Nursing Personnel working in dialysis centers in Oman
2. This procedure can be performed by a nurse undertaking nephrology / heamodialysis training program, provided he/she is closely supervised by experienced dialysis nurse at all times
3. A strict aseptic technique should be maintained throughout the procedure in accordance with the policy and procedure of aseptic technique.
4. Hand washing should be performed according to policy and procedure on aseptic hand washing.
EQUIPMENT
1. Heparin pump (as per the heamodialysis machine)
2. Syringe
3. Heparin
4. Clamp
PROCEDURE
I – LOADING DOSE
| SN | Nursing Action | Rationale |
| 01 | After preparing the vascular access site for dialysis, administer the initial bolus dose of heparin as prescribed. Calculation of heparin is to be done as per prescribed dose. | To initiate the desired action of heparin during the first hour of heamodialysis. |
| SN | Nursing Action | Rationale |
| 02 | Start regular heparin infusion as prescribed after commencing HD. | To reinforce the desired action of heparin bolus. . |
| 03 | Monitor heparin pump hourly. | To serve as a guide in adjusting the appropriate dose of heparin and to ensure that heparin is infused correctly. |
| 04 | Stop the heparin infusion one (1) hour before the end of heamodialysis (patients having AVF) and two (2) hours (patients with AVG) according to patient’s clotting time (optional). – See annex about clotting time – Continue to give heparin until the end of heamodialysis (patients having temporary access) | To prevent prolonged bleeding on the access site after the removal of needles. To maintain the lumens patency. |
II – HEPARIN FREE DIALYSIS
Alert
This is not a routine dialysis; kindly follow up the treating physician’s order. The total volume of Normal Saline to be given has to be calculated for inclusion in weight loss during heamodialysis
INDICATIONS
1. Pericarditis
2. Recent surgery after which bleeding would be dangerous
3. Coagulopathy
4. Thrombocytopenia
5. Intracerebral haemorrhage
6. Any active bleeding
PROCEDURE
| SN | Nursing Action | Rationale |
| 01 | See treating physician’s order for use of heparin in priming procedure. | To perform the right procedure. |
| SN | Nursing Action | Rationale |
| 02 | Rinse the dialyzer every 30 minutes (during dialysis) rapidly with approximately 100 mls saline while occluding the blood inter- line. | To reduce the propensity for extra corporeal circuit clotting. |
| 03 | Use of UF controller to adjust the TMP. | To achieve body weight. |