In dialysis treatment, through which port is Clexane (enoxaparin) administered?

Clexane Administration Port in Dialysis Treatment

Clexane (enoxaparin) should be administered subcutaneously, NOT through any dialysis catheter port, and should be given 6-8 hours after hemodialysis completion to minimize bleeding risk at the vascular access site. 1

Critical Administration Timing

• The daily enoxaparin dose must be administered 6-8 hours after hemodialysis completion to minimize bleeding risk at the vascular access site, as recommended by the American Heart Association 1
• The risk of major bleeding is highest at vascular access sites immediately post-hemodialysis if enoxaparin is given too close to the dialysis session, with a reported major bleeding rate of 6.8% in hospitalized hemodialysis patients 1
• Sheath removal or access site compression should be performed 4 hours after IV enoxaparin or 6-8 hours after subcutaneous enoxaparin to minimize bleeding risk 1

Route of Administration

• Enoxaparin is administered subcutaneously only, never through dialysis catheter ports (arterial or venous lumens) 2, 3
• The FDA-approved formulation is specifically designed for subcutaneous injection using single-dose syringes with automatic safety devices 2
• Dialysis catheters are dual-lumen devices with arterial and venous ports used exclusively for blood flow during dialysis, not for medication administration 4

Why Not Through Dialysis Ports

• Dialysis catheter ports are designed for high-volume blood flow (≥350 mL/min) during hemodialysis sessions, not for medication administration 4
• The arterial port draws blood from the patient to the dialyzer, while the venous port returns filtered blood to the patient—neither is intended for drug delivery 4
• Instilling medications into catheter lumens is reserved for specific antimicrobial or antibiotic "lock" solutions during the interdialytic period, not for systemic anticoagulation 4

Dosing Considerations for Dialysis Patients

• For dialysis patients requiring therapeutic anticoagulation, consider switching to unfractionated heparin as the preferred alternative, as it does not accumulate in end-stage renal disease and allows for better control 1
• If enoxaparin is used, the American College of Chest Physicians recommends reducing the dose to 1 mg/kg subcutaneously once daily (instead of twice daily) for patients with severe renal failure (CrCl <30 mL/min) 1
• The average daily dose of enoxaparin used to achieve therapeutic levels in hemodialysis patients ranges from 0.4-1 mg/kg/day 5

Common Pitfall to Avoid

• Never administer enoxaparin immediately before or during hemodialysis, as this dramatically increases bleeding risk at the access site 1
• The 6-8 hour post-dialysis window is critical for hemostasis at the vascular access site before introducing systemic anticoagulation 1