Abstract: Objective To determine the optimal heparinization protocol for hemoperfusion combined with hemodialysis (HP+HD) using a novel perfusion device (HP110) and to establish quality control tools for HP+HD therapy, including HP+HD installation and priming checklist and nursing quality indicators relating to the incidence of extracorporeal circulation coagulation, so as to provide a reference for clinical nursing quality control.  Methods This study enrolled maintenance hemodialysis (MHD) patients undergoing regular HP+HD therapy using heparin-based anticoagulants (unfractionated heparin or low molecular weight heparin) at Peking University People’s Hospital from June to November 2024. The study was divided into two phases: the initial phase (dynamic heparinization for installation and priming) and the improvement phase (closed-loop heparinization 5-step method for installation and priming). A project management team was established to develop the heparinization protocol, the HP+HD installation and priming checklist, and the nursing quality indicators relating to extracorporeal circulation coagulation.  Results   A total of 52 MHD patients were included (33 males and 19 females), aged 34～77 years (mean 56.8±10.2 years). Among 677 HP+HD treatments, 242 were conducted in the initial phase and 435 were in the improvement phase. During the initial phase and the improvement phase, the rates of extracorporeal circulation coagulation of grade II or more were 9.5% (23 treatments) and 0% (P＜0.001) respectively, and the rates of extracorporeal circulation coagulation of grade Ⅲ were 2.07% (5 treatments) and 0% (P＜0.001) respectively. The rate of recurrent coagulation in the same patient was 26.09% (6/23 treatments) in the initial phase. Monthly quality control score for nursing procedures showed no significant differences between the two phases (t=0.708; P=0.482). In the 435 treatments in the improvement phase, prothrombin time (10.2±0.8s), activated partial thromboplastin time (30.6±3.0s) and fibrinogen (314.0±57.2 mg/dl) were in the normal ranges, a total of 1000 mL normal saline and 12 500 IU of heparin (costed 15.16 RMB yuan) could be saved in a single HP+HD treatment, and the manipulation time was 5 minutes less than that reported in the literature.  Conclusion  The use of the closed-loop 5-step method for heparinization during HP+HD installation and priming significantly reduced the incidence of extracorporeal circulation coagulation and optimized the use of heparin and saline compared to the dynamic heparinization method. The nursing quality indicators, including the rates of grade Ⅱ and Ⅲ extracorporeal circulation coagulation and recurrent coagulation in the same patient, and the HP+HD installation and priming checklist are sensitive and effective tools for evaluating nursing quality of HP+HD installation and priming.

Key words: Heparinization protocol, Extracorporeal circulation coagulation, Nursing quality control; , Hemoperfusion combined with hemodialysis