We have been getting quite a few clotted dialyzer/lines during treatments in one of the clinics that I work at, it seems like the RNs are too busy to investigate these, so I'm helping out. i'm not too knowledgeable when it comes to these....what are some things that causes them?? what have you guys done to try to prevent them?
thanks! any help is appreciated
Increase heparin amount or frequence or saline flushes and make sure proper priming and recirc is being done
Are there a lot of alarms and are they being answered in a timely manner? If the blood pump stops for any length of time clotting starts to happen. As guesty says, proper priming is important too. Air in the system will increase clotting as well. So if the dialyzer is not purged of air before the pt. is put on you will have more clotting. If this is something new, try a different lot of heparin as well - there have been problems with this in the past with certain lot numbers. But I would bet that your problem is more on the technical side of things.
Ruth, when you say our problem is on the technical side of things, do you mean you think there are problems with the machines that may be causing the clotting??
There are some things that can cause clotting that can be directly attributed to the machine. Inadequate deaeration, poorly ocluded blood pump or malfunctioning heparin delivery. It has been my experience(28 years) that clotting can and will happen if the user does not prime correctly(very hard to determine after clot has already formed) or heparin was mis-presribed(if that is a word). If blood lines have kinks in them clotting can happen.
If the machine is in top notch working order and clotting happens it is rarely the machine's fault.
1.Make sure the heparin perscribed is being delivered.(Starting point in syringe vs. post treatment - remaining heparin.) With high pressures in the blood circuit-the heparin pump can be pushed back since the Heparin Pump does not have the power to overcome the pressure.
2. How are you giving the initial bolous?
As Ruth said, BP turning off numerous times due to alarms and not being restarted quickly & heparin issues; are the most common culprits.
Also, slow flow rates can increase chances of clotting.
I also agree with Guest, a properly working machine is very rarely the cause of the problem.
If you have several clinics with same machines, same person servicing them, same dialyzers, & same lots of heparin; leaves different: staff, water system, or pts as possible causes.(of course this isn't all possible factors)
Just saying that it's likely a clinical issue at that unit.
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