Is there a guideline or any research that recommends how long heparin should be used for treatment of fibrin in effluent? Our current policy states to continue the heparin for a minimum of 48 hours after fibrin is noticed (even if the fibrin clears before then). We are considering changing the policy to use the heparin until the fibrin has cleared (not to wait for a full 48 hours) and would like some input. Thanks very much.

Questions About PD

Unknown User, Nurse from _ asked
Is there a guideline or any research that recommends how long heparin should be used for treatment of fibrin in effluent? Our current policy states to continue the heparin for a minimum of 48 hours after fibrin is noticed (even if the fibrin clears before then). We are considering changing the policy to use the heparin until the fibrin has cleared (not to wait for a full 48 hours) and would like some input. Thanks very much.

2 answers

Dr. from China March 4, 2019

To my knowledge, there is no any guideline or research indicating the duration of heparin for fibrin in effluent. In our practice, we only use heparin and saline for catheter blockage suspected to be caused by fibrin for 30 minutes, a single time. We do not use heparin for fibrin in effluent only if there is fibrin clots. 

#1
Nurse, Canada March 4, 2019

Thank you for your question. We are not aware of any research recommending how long heparin should be used for treatment of fibrin in PD effluent. Our local practice is (1):
Heparin

  • Indicated if fibrin is present in bags, for slow drainage and for hemoperitoneum.
  • Used in each exchange for 24 hours and reassessed.
  • Dose (non-peritonitis): 500 units/L IP (page 113).

Of note, there is one published report of heparin induced thrombocytopaenia (HIT) developing in a patient on PD, with the recommendation that heparin should be used judiciously in these patients (2).
 

  1. Gozdzik, A. (Ed). UHN Division of Nephrology – Housestaff/NP Guidebook (July 2018). Available at : https://ukidney.com/nephrology-publications/nephrology-manuals/71-all-nephrology-manuals/274-university-health-network-nephrology-manual
  2. Kaplan GG, Manns B, McLaughlin K. Heparin induced thrombocytopaenia secondary to intraperitoneal heparin exposure, Nephrol Dial Transplant 2005; 20(11):2561–62. https://doi.org/10.1093/ndt/gfh989
#2

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