title: Systemic anticoagulation and bleeding in children with hemodialysis catheters.
abstract: Hemodialysis catheters are routinely flushed with high-concentration heparin solutions to maintain intradialytic patency. The safety of this practice has never been established. This report describes five patients with hemodialysis catheters who were found to be inadvertently systemically anticoagulated perioperatively and had bleeding complications. These patients all had normal preoperative coagulation panels drawn peripherally. Smaller children managed by hemodialysis may be at greater risk for systemic anticoagulation and bleeding than older children and adults from high-concentration heparin flush solutions, particularly during the perioperative period. Guidelines are presented to prevent hemorrhagic complications from inadvertent systemic anticoagulation.
authors.affiliation: Department of Pediatrics, Division of Nephrology, Children's Hospital of Pittsburgh, University of Pittsburg School of Medicine, Pennsylvania, USA. moriml@chp.edu
authors.forename: Michael L
authors.initials: ML
authors.lastname: Moritz
authors.forename: Abhay
authors.initials: A
authors.lastname: Vats
authors.forename: Demetrius
authors.initials: D
authors.lastname: Ellis
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D002408:Catheters, Indwelling; D002648:Child; D002675:Child, Preschool; D006470:Hemorrhage / Q000139:chemically induced*; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D008297:Male; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation
chemical_list: D000925:Anticoagulants; D006493:Heparin