79 year old male.
admitted for bleeding avfistula.
hx of bleeding
on heparin for mitral valve regurgitation.
fistula repair post one day.
temporary tesio inserted at same time.
pt dialyzed through new tesio. bleeding at site reported by dialysis.
gauze applied to insert site, pt returned to room.
Half hour after return to unit, pt has soaked through the gauze and has blood running down from the site, onto his chest and through his gown.
md notified.
pressure dsg applied to wound. pt instructed to lie flat
heparin held for PTT of 166.(thats right...166)per proticol.
PTT redrawn-same result.
md arrives.
pressure dsg removed and site inspected forty five minutes after bleeding began.
constant pressure has been applied to the site for an hour and the patient is still seeping blood. (soaked thru 4 drain sponges with the pressure dressing)
bleeding has slowed down but still active. pt is stable.
site inspected and another pressure dressing is applied. this dressing will be intact until rounds in the morning.
MD orders heparin to be restarted at a slightly lower rate with coumadin to follow in two hours.
you are his nurse...what would you do?