Abstract for presentation at Renal Society of Australasia Annual Scientific Conference

Introduction: The used of heparin has been widely accepted as the standard anti-coagulant in haemodialysis, however, there has been growing concern in the dialysis community on its use for high risk patients. All patients deemed at risk of bleeding i.e. post theatre or post PVC insertion, are dialysed either with no anticoagulation or with minimal anticoagulation. Despite these precautions a number of our patients had unexpected bleeding not after a surgical procedure was performed but after the next dialysis session. Investigations showed a significant rise in APTT level 10 minutes after heparin locking of PVC post dialysis. We conducted a quality project looking at the risk of accidental or unwitting instillation of heparin via PVC locking post haemodialysis and the subsequent danger to patients with bleeding tendency.
Method: We measured the volume of eight types of PVC and compared the results with the manufacturers stated lumen volume and found significant discrepancy. We then changed the amount and subsequently the concentration of heparin lock used for each treatment.
Results: Reduction in concentration of heparin from 5000units per ml to 1000 units per ml was found to be the safest method of avoiding post dialysis bleeding in patients.
Conclusion: The findings of this quality project provided evidence for our revised policy and change of practice at our Haemodialysis Units. Since the implementation of this new practice in PVC locking in November 2005, there has been no reported incidents of unexpected bleeding in any patients post haemodialysis.