Heparin Dialysis Research Articles

Perioperative management of cataract surgery in patients with severe systemic diseases

Objective To evaluate the efficacy of perioperative management in cataract patients with severe systemic diseases. Methods Data of 55 eyes of 40 cataract patients with severe systemic diseases in Bazhou Area of Xinjiang were collected and retrospectively analyzed. They underwent cataract surgery. The preoperative managements included discontinuing anticoagulant drugs 7 days preoperatively in patients with coronary artery stent implantation and cerebral infarction. If there was no bleeding 3 days postoperatively, the anticoagulant drugs were restarted.No Heparin used during renal dialysis in patients with renal insufficiency from 1 day before surgery to 7 days after surgery. If there was no bleeding 7 days postoperatively, the Heparin dialysis was restarted. Patients with idiopathic thrombocytopenic purpura accepted blood transfusion preoperatively, which made platelets reaching more than 50×109/L. Patients with leukemia in plateau were kept in a stable phase after systemic treatment preoperatively. The surgical options included phacoemulsification in 52 eyes of 38 patients and extracapsular cataract extraction in 3 eyes of 2 patients. Posterior chamber intraocular lens were implanted in capsular bag of all patients.The follow-up time was 2-4 months. Results Three days postoperatively, cornea edema occurred in 6 eyes, anterior chamber exudates in 3 eyes, and temporary elevation of intraocular pressure in 1 eye respectively. One week postoperatively, severe anterior chamber exudates in 2 eyes, viral keratitis in 1 eye. No obvious progression of systemic disease observed during follow-up period. The visual accuity was improved after surgery. Conclusion Systemic diseases are positive controlled, they can undergo cataract surgery successfully and gain better prognosis. Key words: Cataract; Perioperative period; Systemic diseases, severe

The design and clinical application of a new type of disposable heparin free dialysis tube

Objective To investigate the clinical effect of a new type of disposable heparin free dialysis tube in uremic patients without heparin dialysis. Methods A total of 110 patients without heparin dialysis were divided into control group and observation group by random digits table method with 55 cases each. Based on the same pre dialysis and dialysis for heparin saline flushing of discontinuous saline on the control group using the traditional dialysis pipe for hemodialysis without heparin, the observation group used disposable non heparin dialysis pipe for hemodialysis without heparin. The number of patients with venous catheter blockage, blood loss and completion of dialysis time in two groups was recorded. Results The number of patients with venous catheter blockage, blood loss and completion of dialysis time was 6, 6, 47 cases in control group and 0, 0, 54 cases in observation group. The differences were statistically significant (χ2=4.407, 4.407, 4.356, P<0.05). Conclusions The new disposable heparin free dialysis tube can reduce the loss of blood and prolong the treatment time, and the operation is simple, safe and effective, and has good application value and application prospect. Key words: Renal dialysis; Nursing care; Coagulation; Vein pot; Without heparin

Research in application of adsorption method combined with warm saline in heparin- free dialysis

Objective To investigate the efficacy and safety of using adsorption method combined with warm saline in heparin- free dialysis for patients with high risk bleeding tendency in order to reduce blood ag-glutination in the dialyzer and pipeline. Methods 60 patients with high risk bleeding tendency who were to undergo long- term hemodialysis (HD) were divided into the experimental group and the control group with 30 eases in each group,they both adopted heparin- free dialysis.The control group used saline washing of room temperature, while the experimental group adopted adsorption method combined with warm saline during washing. The completion of dialysis as well as the agglutination in the dialyzer and pipeline were ob-served. Results Number of patients who completed the dialysis were more, the completion rate of dialysis was higher and agglutination of dialyzer and pipeline decreased in the experimental group than those in the control group. Conclusions Agglutination of dialyzer and pipeline can be reduced and the aim of safe and effective heparin- free dialysis can be reached when using adsorption method combined with warm saline. Key words: Hemodialysis; Non- heparin dialysis; Saline wash; Care

Low polymorphonuclear cell degranulation during citrate anticoagulation: a comparison between citrate and heparin dialysis

Haemodialysis (HD)-induced bio-incompatibility includes alterations in both cellular elements and humoral factors. As far as polymorphonuclear (PMN) cells are concerned, an increase in both adhesion and degranulation has been reported. However, whereas increased PMN adherence and aggregation is highly linked with early transient complement activation, degranulation seems a continuous process, independent from the formation of complement degradation products. In the process of cell activation, including PMN degranulation, divalent cations (Ca2+) appear to play a pivotal role. As regionally administering citrate creates an almost Ca(2+)-free environment within the dialyser, it is tempting to speculate that Ca2+ dependent phenomena of bio-incompatibility, originating within the dialyser, can be attenuated by substituting conventional heparin for citrate. Therefore, both anticoagulation modalities were compared in 10 stable patients, undergoing haemodialysis (HD) treatment with cellulose-triacetate membranes (CTA) only. Apart from the intracellular granule products myeloperoxidase (MPO) and lactoferrin (LF), the classical parameters of bio-incompatibility, peripheral blood neutropenia and complement activation, were measured. Analysis of MPO and LF gradients across the dialyser (concentration in efferent line-concentration in afferent line) suggested that degranulation is an early process, that occurs mainly within the extracorporeal circuit. Citrate abolished the release of MPO almost completely, whereas LF release was partially inhibited. Neither neutropenia, nor complement activation could be correlated with the occurrence of degranulation. HD-induced PMN degranulation seems largely independent from complement activation, but primarily reliant on Ca2+, at least in the case of CTA membranes.

Controlled Study of Heparin versus Epoprostenol Sodium (Prostacyclin) as the Sole Anticoagulant for Chronic Hemodialysis

We performed a controlled parallel study comparing the effects of heparin sodium to epoprostenol sodium (prostacyclin sodium, Flolan) during hemodialysis in 30 dialysis patients. Mean fiber bundle volume loss and dialyzer function were similar with both anticoagulation methods. Intradialytic symptoms occurred in 100% of the epoprostenol dialyses and 88% of the heparin dialyses, but only 10/325 epoprostenol and 3/374 heparin dialysis were discontinued prematurely because of symptoms. Long-term hemodialysis with epoprostenol is safe and effective. Epoprostenol may be a suitable alternative to heparin in some dialysis settings.

Regional anticoagulation: hemodialysis with hypertonic trisodium citrate.

We have developed a simplified method for performing regional citrate anticoagulation during hemodialysis. High ultrafiltration rates and specialized equipment were obviated by the use of a 1.6-mol/L trisodium citrate solution and a standard calcium-containing dialysate. Thirty-six dialyses were performed with this technique on 14 stable and 22 high bleeding risk patients. There was no significant decline in plasma-ionized calcium during citrate dialysis, ie, 3.85 +/- 0.34 mg/dL (mean +/- SE) predialysis, to 3.31 +/- 0.26 postdialysis; furthermore, no patient developed neuromuscular symptoms or evidence of cardiovascular instability from hypocalcemia. Serum sodium rose with this procedure, but not to hypernatremic levels. This method of citrate dialysis is safe and effective during continuous blood flow (double-needle) hemodialysis, and is no more difficult to perform than conventional heparin dialysis. Single-needle (reciprocating blood flow) hemodialysis was successfully performed by the additional use of a calcium-free dialysate and separate calcium chloride infusion (10% calcium chloride), but risks the production of unexpected hypercalcemia.

Regional sodium citrate anticoagulation in patients with active bleeding undergoing hemodialysis.

Sodium citrate was used as a regional anticoagulant in the dialysis system in four patients with acute renal failure and active bleeding of various sources during a total of 38 dialysis treatments. All four patients had exacerbation of existing hemorrhage with low-dose heparin dialysis. A special circuit was used through which sodium citrate was infused into the arterial sleeve of the dialysis blood line; dialysis was achieved against calcium-free bath and calcium was infused into the venous sleeve of the dialysis blood line. When data was compared to low-dose heparin dialysis, citrate anticoagulation is as effective, carries no risk of exacerbation of bleeding, and had negligible adverse effects.

Toxicity of plasma from hemodialysis patients treated with heparin or prostacyclin.

Hemodialysis was performed in 6 uremic patients with either a bolus dose of 5 000 IU heparin or prostacyclin at a constant infusion rate of 5 ng/kg/min. Clinical data, plasma triglycerides (TG), free fatty acids (FFA), platelet aggregation, white blood cell count and plasma toxicity were measured prior to and during both procedures. No serious side-effects were recorded. Heparin induced a fall in plasma TG, a rise in FFA and increased plasma toxicity. Prostacyclin infusion had no effect on these parameters. During both tests a marked drop in white blood cell count was found 15 min after the start of hemodialysis. During heparin dialysis no clotting was observed in the extracorporeal circuit. During prostacyclin dialysis clotting was observed at the venous line in three cases.