Read an old thread on heparin usage and home patients said they averaged from about 3000 to 6000 units on their heparin bolus. Wondering if anyone has found that their heparin requirements have changed since they have been on home txs–do you find that your need for heparin has increased or decreased?
Also are there any other reasons why blood does not return well at the end of tx other than heparin related?
This is going to be different depending on which machine you are using and if the machine has a heparin pump. If you are only giving heparin at the beginning you’ll need a bigger bolus to clear the artificial kidney. If you have a pump delivering heparin throughout the treatment then you can use a smaller bolus.
My heparin needs have stayed pretty much constant over time. With a pump (incenter) I use a 5cc bolus and 1.5/hour, off with 30 minutes to go. For a 2 hour run on the Aksys PHD I’ll give myself 7cc bolus; for a 2 hour 50 minute run I’ll give myself a 6 cc bolus and then inject another 5 cc with two hours to go. On the NxStage I used a 6cc bolus for a 3+ hour run. I use more heparin on the Aksys then on the NxStage because on the Aksys I am trying to get a month of use out of the blood tubing set, while on the NxStage it doesn’t matter if the kidney clots a bit.
[quote=Unregistered;11640]Also are there any other reasons why blood does not return well at the end of tx other than heparin related?[/quote] I guess it depends what you are referring to – streaking of the artificial kidney fibers is probably a heparin issue. If the lines seem pink or red-ish you may just need more saline. On daily dialysis I don’t have trouble controlling fluid so I am willing to use more fluid during rinse back in an effort to conserve red blood cells.
Another issue with the NxStage is that you can’t directly control your run length so if you give yourself a haparin bolus assuming you’ll run at a certain blood pump speed you could end up neeoing more heparin if you have to run at a slower speed for a longer run.
I think there’s a handful of home patients that are not using heparin anymore…I don’t use it and have ran up to 4 hours heparinless…hehe 
I’ve spoken to another patient who doesn’t use heparin either…
[QUOTE=Gus;11651]I think there’s a handful of home patients that are not using heparin anymore…I don’t use it and have ran up to 4 hours heparinless…hehe
I’ve spoken to another patient who doesn’t use heparin either…[/QUOTE]
I’ve read where you’ve mentioned this before, but wish you could provide more info so I could run it by my neph. If this was better for patients wouldn’t more nephs have their patients using it…maybe not? What are the pros and cons of each?