Systemic anticoagulation and bleeding in children with hemodialysis catheters

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.