The effect of citrate dialysate on intradialytic heparin dose in haemodialysis patients: study design of a randomised controlled trial

Table 1 Visual Clotting Score and Heparin Protocol

Clotting Score	Dialyser/Venous Chamber Appearance (at the end of each HD session)	Heparin Dose Adjustment (for the next HD session)
0	Clear	Decrease^a boost by 200 units and decrease running dose by 200 units/h
1	Few strands/small clot	Decrease^a boost by 200 units and decrease running dose by 200 units/h
2	½ clotted	Increase boost by 200 units and increase running dose by 200 units/h and maintain this new heparin dose for the remainder of this study phase only.
3	¾ clotted (able to return blood)	Increase boost by 300 units and increase running dose by 300 units/h
4	Completely clotted (unable to return blood)	Increase boost by 400 units and increase running dose by 400 units/h

HD haemodialysis
NOTE
1) If there is unusually prolonged bleeding from vascular access sites post-HD, for the next HD session, decrease^a heparin running dose by 200 units/h and turn heparin off 30 min earlier than usual
2) If there is a discrepancy in score between the dialyser and the venous chamber, the heparin dose adjustment is based on the dialyser clotting score
^aThe minimum possible heparin boost and running dose are 500 units (boost) and 500 units/h. If the heparin dose is to be decreased to less than 500 units (boost and/or running dose) for the next HD session, discontinue the boost and/or the running dose

ISSN: 1471-2369