Is it necessary to put heparin into the line going into the fistula? I don't mean after you are connected to the machine, I mean in the short line that extends from the needle. At my unit they use a syringe of heparin and put it into the access before starting treatment. I feel like my access get lumpy and hard after this. Shouldn't the heprin that goes in the machine go through the access and be enough to keep the access from clotting?

It is best to administer the heparin to the patient and wait 3 to 5 minutes before starting the dialysis treatment. This allows time for the heparin to become distributed in the patient's plasma. This way the blood that enters the blood tubing and the dialyzer is anti-coagulated right from the start of the dialysis. This minimizes the clotting that can occur in the extracorporeal circuit from the very beginning of the treatment. It is also important if you are on a high flux dialyzer. Heparin's molecular weight is small enough that if it is not bound to protein it can be removed by the high flux dialyzer. This may result in clotting in the system during the treatment because the patient has not received his full prescribed dose of heparin. Clotting in the system reduces the effective surface area of the dialyzer and reduces the clearance potential of the dialyzer. This can adversely affect the level of dialysis the patient receives. When the heparin is given to the patient into the access prior to starting the dialysis the heparin has a chance to bind with protein. The heparin/protein complex is large enough that it will not pass through the high flux dialyzer. The patient gets the prescribed dose of heparin.

Giving heparin through the machine is faster for the clinician, but not good for the patient. Administering the heparin into the patient's access and waiting 3 to 5 minutes is better for you. You should thank your dialysis clinician for being so conscientious. They are doing what is best for you.

If your access is getting bumpy and hard it may be due to lack of rotating sites or other cannulation issues. Most likely it is not related to the adminstration of heparin.