From the FDA Drug Label
A dose of 25 to 30 units/kg followed by an infusion rate of 1,500 to 2,000 units/hour is suggested based on pharmacodynamic data if specific manufacturers' recommendations are not available. The recommended approach for preventing clotting in dialysis lines, specifically for extracorporeal dialysis, is to administer heparin at a dose of 25 to 30 units/kg followed by an infusion rate of 1,500 to 2,000 units/hour 1.
- Key points:
- Initial dose: 25 to 30 units/kg
- Infusion rate: 1,500 to 2,000 units/hour
- This approach is based on pharmacodynamic data and is suggested when specific manufacturers' recommendations are not available.
From the Research
The recommended approach for preventing clotting in dialysis lines is to use heparin 1000 U/ml or 4% sodium citrate as a lock solution, as these concentrations have been shown to maintain patency of tunneled central venous catheters for dialysis while minimizing the risk of systemic anticoagulation 2. The use of heparin as a lock solution is a common practice in dialysis, and the concentration of 1000 U/ml has been found to be effective in preventing catheter malfunction while reducing the risk of bleeding complications.
- The study by 2 found that heparin 1000 U/ml and 4% sodium citrate are suitable choices for lock solution to maintain patency of tunneled central venous catheters for dialysis.
- Another study by 3 compared the effectiveness of two heparin concentrations (10,000 and 1,000 U/mL) in preventing catheter malfunction and found that the use of a lower concentration of heparin was not associated with an increased risk of catheter malfunction.
- However, it is essential to note that the use of tissue plasminogen activator (t-PA) as a locking solution may also be effective in preventing clotting, as shown in the study by 4, which found that t-PA 2 mg preserved dialysis catheter performance and did not cause any bleeding or catheter thrombosis.
- In terms of the Davita protocol, the most recent and highest quality study 2 suggests that heparin 1000 U/ml or 4% sodium citrate should be used as a lock solution to prevent clotting in dialysis lines, rather than relying on a specific protocol.
- The study by 5 also found that continuous saline infusion (CSI) may be a better method of preventing the extracorporeal circuit from clotting when heparin-free dialysis is indicated, but this is not directly related to the use of heparin or citrate as a lock solution.