Intermittent saline flushes or continuous saline infusion: what works better when heparin-free dialysis is recommended?

Edward Zimbudzi

Department of Nephrology, Monash Health, Monash Medical Centre, Clayton, Melbourne, VIC, Australia

Introduction: Coagulation-free dialysis, also commonly known as “heparin-free” dialysis, can be a challenging procedure as it increases the risk of clotting the dialysis circuit. Utilizing a better saline flushing technique can lead to improved patient outcomes as well as huge financial benefits to the health institution. The purpose of this study was to compare the effectiveness of continuous saline infusion (CSI) and intermittent saline flushing (ISF) in preventing clotting of the dialysis extracorporeal circuit (ECC).
Methods: Fifty heparin-free treatments were randomized into two treatment arms, namely CSI and ISF. Predialysis full blood count and coagulation studies were performed for all patients. During ISF, 100 mL saline was infused via the arterial line every 30 minutes while occluding the blood inlet line. Normal saline was infused into the ECC at a rate of 200 mL/hour throughout the duration of dialysis under CSI. The ECC was inspected for clotting and graded accordingly post-dialysis.
Results: Seventy-six percent of the CSI treatments were completed without losing the ECC while 52% of the ISF treatments were also successful. Patients who were treated with CSI were less likely to have clotted ECCs (odds ratio 3.4, 95% CI, 1.04 to 11.2; P = 0.04). No significant differences existed between the two groups’ hematological factors that could influence clotting, such as hemoglobin and platelets.
Conclusion: This study demonstrates that, when heparin-free dialysis is indicated, CSI might be a better method of preventing the ECC from clotting. There is a greater chance of realizing long-term benefits to patients and the health service with the CSI method since there is a likelihood of a reduction in the use of erythropoietin-stimulating agents and blood transfusions with the CSI method.

Keywords: continuous saline infusion, hemodialysis, heparin-free dialysis, intermittent saline flushing