How much Heparin are you getting per treatment?
Non-zero-nada… 
I clot very easily so use 6000 units given in a bolus before my approximate 3 hour treatment. I may try lowering it a bit and see if I get clots in the dialyzer, however, since I stop bleeding within a couple of minutes it appears to be an acceptable level for me.
Cathy
P.S.
Oh Cathy, where are your vacation pics with NxStage? :roll:
Was 5 up front & 1 per hour until an hour before coming off, on day-time dx (5 hours+/-)
Now 6 up front & 1.1 per hour " " " on nocturnal…seems to be more clotty stuff in the catchers than there used to be afterward tho. :roll:
Me… 1 ml bolus at start, 1 ml per hour for 7 hours. Total 8.0ml per 8 hour treatment. I hate to say never, but I’ve never, ever had any clotting anywhere.
Pierre
OMG 6000?!? LOL I thought I had alot, I do 4000 bolous plus 1.3/hr and get a little bit of clot in the bubble trap and arterial pressure line thingy.
Pierre, if you dont get any clots at all, how long do you take to stop bleeding?
I hold my sites for 10 minutes, only because if it does start bleeding after, at home when you’re alone, it a lot of trouble. But I think I could probably get by with 5 minutes. I’ve always held 10 minutes since I started dialysis 4 years ago. My heparin dose has never changed.
Pierre
Why is it trouble if it starts bleeding at home?
It’s trouble because you only have one hand to work with. If you start bleeding under the gauze and tape and you don’t remove the soaked gauze and tape first, you could be holding for a long time before the buttonhole clots enough to stop bleeding. So you have to remove the tape and gauze very quickly so you don’t splurt all over the place, while at the same time putting on a fresh gauze to hold with. While you’re doing all this, you usually have blood running down your arm onto the floor, the bed, your pants… etc. It can be very messy.
Pierre
Ive only ever had a spurt once, which was when I first started HD. I make well sure its stopped before I put the bandaid on. I have had a bleed once at home, I just grabbed the closest towel and held it until it stopped. Took about 15 minutes. It only bled because I got my partner to take the needle out, and he had never done it before and took it out too slow, so it bled into the tissue. Apart from that one time Ive never had it bleed afterwards.
It is scary when you are alone. Im mostly not alone when Im going on, but every couple of weeks Im alone when Im coming off. I dont like it, but I dont really have a choice.
I think if you have a bleed its important not to panic, just grab a towel or sheet or anything and apply pressure. Call ambo if needed.
After almost 4 years of dialysis, I just know that sometimes you’ve held properly for the exact same amount of time as any other time, you make sure it’s not bleeding, put your tape on, start doing your post-tx vitals, get up to do your standing BP or walk over to the scale, and all of a sudden, you’re bleeding. It starts oozing out from under the cause, and before you know it, it’s dripping all over the place. Sometimes, you can start bleeding from the first site while you’re taking the needle off the second needle site. It doesn’t happen ever day, but it certainly can happen now and then. Sometimes it’s just a matter of maybe moving your arm carelessly as you get up and start doing things. Upper arm fistulas are especially prone to this because the flow and the pressure are so powerful up there.
Pierre
Ive never had that happen peirre. Have you had your heparin dose reveiwed lately?
I’ve spurted too, usually when I start using the arm too soon, and Pierre is right it is usually messy. You don’t end up losing that much blood but it sure looks like it.
I think somedays are just that way. I’ll have one slow to stop and the other stops in seconds, so it isn’t the heparin. I almost always hold the first one’s taped site when I remove the second needle as messing around can cause it to start up again. Sure I could hold another 5 minutes instead of the two I do, but what a waste of time if I only spurt maybe once every couple of months and it is almost always cuz I got careless.
Ahh, the life of a home dialysis patient, but I’d have it no other way!!
Cathy
home hemo 9/04
Hey guys,
why not go Heparinless? I’ve been using no heparin for over a year now…
Ask your Dr. about it…tell your Dr. about me. Am living proof that its possible…
By no herparin, do you mean you use absolutely nothing at all to stop clotting? What are your lines like after running off?
I even have to use heparin to flush the venous cannula after insertion :?
Correct, no heparin at all. I only take two baby asprin every other day…after coming off the lines are like always, no clots, just a few streaks on dialyzer that’s all. Pressures have been excellent…all I use to flush venous cannulation is saline…nothing else.
Anyway, everyone is different and may respond differently but it doesn’t hurt to ask Dr. or give it a try. Maybe even some people can’t take asprin at all but if you can by Dr okay then perhaps you can try it.
At first before I tried I was nervous and scared but realized that with careful withdrawal you can figure outr whether you can go heparinless.
Sorry amba_79,
that was me, forgot to login.
I am already on one aspirin per day, heparin flush for venous, and 4000/1300 heparin on the machine, and I still get a bit of your usual clotting in the lines :shock:
How much you weigh? I myself only weigh from 65.5kg-70kg …how many miligrams asprin is that you take?
EDIT: Reason I ask is that larger people may need more…DON’T DO THIS WITHOUT ASKING DR. FIRST!