Q & A No 1

We have received a question from a reader:

".i one to ask some my patients, the dialyser cloted, after iuse above 8 time the dialyser i discard because can't pass test with renatron. Hep i used 2000iu started and 1000iu hourly and last hour no heparin. can i add more if not enough hep. or any suggestion can i do. Can you highlight for me. may centre i use for 15 times passed with renatron machine......"

Our reply:......


"Dear AK,

First and foremost, all dialysers are for "sinlge use" only.

Due to economic and other reasons, "reuse" is practiced. "Reuse" can be carried out either by manually reporcessing the dialysers or by using semi-automated or fully automated reprocessors.

The "reuse" protocol employed by each haemodialysis centre (HDC) shall be their management responsibility to ensure patient safety and best treatment outcome.

There are a number of tests being carried out on a dialyser while being reprocesed by a "Renatron", a fully automated reprocessor. Two major test which when either fails will not allow further processess to be carried out are the "Bundle Volume" test and "Pressure" test.

We shall assume that the test referred is the "bundle volume" test. 

What it means is the volume within the "hollow-fibers" of the dialyser does not meet the volume set as a minimum standard. The minimum standard approved by AAMI is 80% of that of a new dialyser of the same make and size.

Failing to meet the minimum standard of 80% may be due to a number of reasons:

1. "Hyper-clotters"
2. Blood clots

"Hyper-clotters" are metabolic materials produce by certain dietary intake. If the failure is due to this then the patients needs to be counselled on his/her dietary intake.

If it is due to blood clots, due care must be given to the regime in giving anti-coagulant, in this case heparin. The recommended anti-coagulant regime is bolus dose of 50iu/kg is given at the begining of treatment followed by 10-20iu/kg per hour.

As per your question, the following is our suggestions:

1. You may want to increase you bolus dose by an incrementof 500iu up to 4000iu in addition to your 2000iu presently being given depending on the patient's body weight.

2. You may also want to increase your hourly dose by 500iu for the first 2 hours.

Adjustment to the administration of the 3rd hourly dose will depend on post treatment bleeding time. 

Please note that due considerations must be given when handling patients with bleeding problems such as retinal bleeding, gastritis etc. and those on blood thinners such asprin etc.


Other suggestions are:

1. Instead of priming the "extra-corporeal" blood pathway with "heparinised saline" during the priming phase, you may want to prime with only Normal Saline. During the recirculation phase before connecting the patient, push in 2000iu of heparin and let it recirculate for at least 10 minutes before connecting to the patient.

This will help to heparinsed the internal pathway of the "extra-corporeal" blood pathway at a higher and more concrentrated heparin solution and prevent unnecssary clotting. 


2. At the end of the dialysis while returning the "extra-corporeal" blood back to the patient, push in any remenant heparin not used into the "extra-corporeal" blood pathway. Ensuring that the heparin will reach the dialyser before the blood pump is switch off. 

This will ensure any unused heparin is ustilised to prevent blood to clot in the"hollow-fibers" while waiting to be reprocessed, thus making full use of any extra heparin otherwise going to be discarded.

We welcome any other suggestions.....