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haemodialysis
Lestariningsih
Subbag Nefrologi / Hipertensi
Bag Penyakit Dalam FK UNDIP/RS Dr Kariadi
Highlight
contact with plastic tubing, the dialysis membran and air
in the HD circuit stimulates the clothing cascades
excessive clotting in the dialysis circuit and filter need to be
discarded, in adult, this can mean the loss of 120-250 ml of blood
clotting within an HD circuit can be minimised through aprpropiate
use of anticoagulant therapy
periodic anticoagulation is normally given during the dialysis
treatment
Georgina Follows Hd
Introduction
Blood comes into contact with extrinsic factors during
haemodialysis.
Heparin is the most commonly used anticoagulant during
dialysis.
Administration of heparin
Bolus dose at the beginning of dialysis
Continuous infusion during dialysis.
Both of these methods are prescribed and can be altered to
tailor each patients needs.
Georgina Follows Hd
Georgina Follows Hd
Extrinsic pathway
Damaged tissue thromboplastin released initiates
formation of prothrombinase in presence of Factor X and
calcium ions.
The coagulation cascade then occurs by using thrombin
an enzyme that converts fibrinogen into fibrin. This forms
a mesh trapping the formed elements of blood thus
forming a CLOT.
Georgina Follows Hd
QUESTION???
Which pathway
is initiated during
haemodialysis?
Georgina Follows Hd
Heparin
Discovered in 1916 by McLean
Anticoagulant found in the liver
Porcine and bovine preparations
Molecular weight = 3000 to 30000 Daltons
Binds to thrombin inhibitor ANTITHROMBIN III >
inactivates active Factor X and inhibits conversion of
prothrombin to thrombin
Georgina Follows Hd
Advantages of Heparin
I.V. direct access
Cheap
Metabolised naturally by the liver
Acts quickly and effectively on the intrinsic pathway
Reversed quickly and easily by Protamine
Long, established history of use
Georgina Follows Hd
Disadvantages of Heparin
Bleeding
Hyperlipidaemia
Thrombocytopenia
Allergic reactions
Pruritis
Alopecia
Osteoporosis
Georgina Follows Hd
Assessment of coagulation
Clotting times APTT (Actual Partial thromboplastin
Time) or ACT (Activated Clotting Time) 120 secs
Observe for signs of clotting
- Darkened blood
- Streaks in dialyser
- Clots / fibrin rings in chambers
- Blood entering venous isolator
- Rising / falling venous pressure
Georgina Follows Hd
Georgina Follows Hd
Georgina Follows Hd
Georgina Follows Hd
Advantages
Safe, effective & decreased bleeding risk
Simple single dose required
Reduced cholesterol and triglyceride levels
Reduced alopecia
Disadvantages
Expensive, long half life, not use ACTs
Georgina Follows Hd
Future
Coating of elements of
circuit with active
heparin.
Non-thrombogenic
membranes.
Heparinised coated
cartridges capable of
removing heparin
infused into the extra
corporeal circuit.
Georgina Follows Hd
QUESTIONS
Georgina Follows Hd
GROUP WORK
A patient complains of loss of hair over the past
couple of months. She has minimal heparin on
dialysis, but still no change, what would you do??