Which scenario most strongly suggests the need to increase heparin during dialysis?

• A. The patient develops bleeding
• B. There is minimal clotting in the circuit
• C. Dialysis runs without any issues
• D. Clotting is still occurring in the extracorporeal circuit

Answer: (D)

During dialysis, the extracorporeal circuit can trigger clotting on the artificial surfaces, so anticoagulants like heparin are used to keep the circuit patent. If clots keep forming in the circuit despite the procedure running, increasing the heparin dose helps suppress the coagulation process and maintain blood flow through the dialyzer. Bleeding would argue against more heparin, and a clean run or minimal clotting already suggests the current level is adequate.