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Table 1 Visual Clotting Score and Heparin Protocol

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

Clotting Score Dialyser/Venous Chamber Appearance (at the end of each HD session) Heparin Dose Adjustment (for the next HD session)
0 Clear Decreasea boost by 200 units and decrease running dose by 200 units/h
1 Few strands/small clot Decreasea 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
  1. HD haemodialysis
  2. NOTE
  3. 1) If there is unusually prolonged bleeding from vascular access sites post-HD, for the next HD session, decreasea heparin running dose by 200 units/h and turn heparin off 30 min earlier than usual
  4. 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
  5. 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