Visual summary
Make anticoagulant exposure, access findings, and the dialysis anticoagulation plan explicit.
Text version
Drug → dose → last dose
At each treatment document the anticoagulant name, prescribed dose, last dose actually taken, and indication. Include aspirin/clopidogrel, new NSAIDs, interacting prescriptions, missed doses, and post-hospital changes. Clarify conflicting orders before circuit heparin.
Check the dialysis order
The circuit anticoagulation plan must address the patient’s medicines and bleeding risk. Clarify an incomplete order before giving heparin; an oral anticoagulant does not by itself specify how the circuit should be managed.
Look for bleeding
Ask about dark stools, visible blood, bruising, nosebleeds, falls, and head injury. Assess access bleeding and hematoma formation, and compare hemoglobin and ordered INR results with the patient’s prior pattern.
Head strike or major bleed → now
Report any head strike immediately, even if the patient initially feels well. New headache, vomiting, confusion, weakness, syncope, uncontrolled access bleeding, or a growing hematoma requires urgent/emergency assessment. Do not send the patient home without the clinical plan.
Avoid independent changes
Do not stop, double, reverse, or substitute an anticoagulant without an authorized plan. Persistent needle-site bleeding can also reflect access disease; inspect and report it rather than assuming medication is the only cause.
Handoff the next-dose question
Give drug/last-dose time, event time, vital signs, Hb/ordered INR, bleeding duration, and circuit findings. Confirm who decides the next dose and procedure plan. Do not independently hold, double, or reverse anticoagulation.