CHBT Anticoagulation in Hemodialysis

Question 1

Why is anticoagulation necessary during hemodialysis?

Accepted Answer

Blood contact with the extracorporeal circuit activates the coagulation cascade, which would clot the dialyzer and tubing

Answer

Anticoagulation prevents the dialyzer membrane from rejecting blood cells

Answer

It is required to maintain the patient's dry weight during treatment

Answer

It prevents dialysate from entering the bloodstream through the membrane

Question 2

What is the most commonly used anticoagulant in hemodialysis?

Accepted Answer

Unfractionated heparin (UFH)

Answer

Warfarin (Coumadin)

Answer

Aspirin

Answer

Rivaroxaban (Xarelto)

Question 3

For a patient at high bleeding risk (e.g., post-surgery or active GI bleed), which hemodialysis anticoagulation approach is preferred?

Accepted Answer

No-heparin (heparin-free) dialysis with frequent saline flushes to maintain circuit patency

Answer

Double the standard heparin dose to ensure the circuit does not clot

Answer

Use warfarin systemically the night before dialysis instead of heparin

Answer

Switch the patient to peritoneal dialysis permanently

Question 4

What does ACT (Activated Clotting Time) measure in the context of hemodialysis anticoagulation monitoring?

Accepted Answer

The time for whole blood to clot, used to assess the adequacy of heparin anticoagulation

Answer

The rate at which heparin is cleared from the patient's bloodstream

Answer

The concentration of platelets in the post-filter blood sample

Answer

The osmolarity of the dialysate adjusted for anticoagulant content

Question 5

A patient on hemodialysis is known to have heparin-induced thrombocytopenia (HIT). Which anticoagulant is safe to use as an alternative?

Accepted Answer

Argatroban or lepirudin (direct thrombin inhibitors)

Answer

Low-molecular-weight heparin (enoxaparin)

Answer

Protamine sulfate

Answer

Citrate only in peritoneal dialysis patients

Question 6

What is the role of the priming step in anticoagulation preparation before connecting a patient to the hemodialysis circuit?

Accepted Answer

Priming with heparinized saline coats the circuit surfaces, reducing thrombogenic activation when blood contacts the lines

Answer

Priming removes endotoxins from the dialyzer by flushing with heparinized saline

Answer

Priming tests the blood pump speed before the patient is connected

Answer

Priming equilibrates dialysate concentration within the dialyzer fiber bundle