I am trying to identify all the contributing factors for clotting of the dialyzer/lines leading to poor returns. I understand that heparin is the first thing to look at and I understand there are quite a few others like weight gain, change in meds or a faulty dialyzer. Can anyone name any others and could anyone lead me to an article on this subject?
Boy…this sounds like a question to ask a renal technologist (dialysis machine technician). I hadn’t heard that changes in diet or medications are risk factors for blood line clotting. I know if patients who are supposed to take blood thinners stop taking them, they risk their body producing clots. These clots could form anywhere in the body. If the patient hasn’t informed the clinic and the clinic is using a certain heparin dose based on the patient taking Coumadin (for example), it’s possible that the line and kidney might clot because the blood thinning capacity of the heparin alone would not be enough.
Vitamin K helps people who have blood that doesn’t clot well to clot normally. I’m not a dietitian but I wonder if eating foods high in Vitamin K or taking high doses of Vitamin K supplements could affect how the body clots which might clot the dialysis access. I don’t know if that would carry over to the dialysis line and dialyzer.
As you say, changes in heparin dose can cause the blood to clot in the line or the dialyzer. Also, obviously, if the blood line kinks or the blood pump stops and blood isn’t pushed through the lines like it should be, blood can clot in the lines and the dialyzer.
Now Beth, being the awesome researcher you are, I felt sure that you would find an article for me (smile). A RN I know suggested I put in anticoagulation-dialyzer or hyper coaguability-don’t know if that’s spelled correctly-scary medical jargon lol!
I doubt most machine techs could answer my question, but a top notch one might be able to. Hard to find that type.
I assume if you gain weight, you may need more heparin. Different meds affect clotting (anticoagulants, aspirin, etc.) Newer filter materials are less likely to form clots than the older type.
But, if everything is the same (Doctor doesn’t make changes to your meds, you haven’t gained 20 lbs, you didn’t eat spinach for the last three meals in a row, etc.) your heparin dose wouldn’t change much.
My wife is on a bolus of 6000u at the beginning of treatment. We have adjusted that up and down a few times looking for differences in the filter (clots, streaks, etc.). I am a big believer in minimal effective dose on any medicine. We have used as little as 4000u and as many as 10,000u. 6000u seems to work for us as well as a larger dose. Talk to your clinic staff before you start making any changesand see if they have suggestions.
When I was in-center I was given a bolus of 4000 heparin and no hourly and it never needed to be adjusted for all the years I was there. My txs were 4hrs. Going home with NxStage I was put on a bolus of 3000 for the shorter txs and it worked perfectly for the first 6 months, not a single poor return. Then I started having sporadic poor returrns. My nurse had me go up on heparin. I continued to have sporadic poor returns. So, I was told to go up on heparin again. I finally got as high as 6500, but it did not solve the problem, because it turned out not to be a heparin problem. There are other reasons for poor returns and this is what I have been researching. I, too, am a believer in minimal effective dose.