Subq Heparin

[JTworoger]

I don't know how it is on other Medical floors, but on the medical floor I currently work on the hospitalist group goes extreme with the subq heparin. The big problem with this is we have to scan another nurse before we can even give the heparin to the patient and that takes large amounts of time to hunt down another nurse in the middle of med-pass.

If I have an ambulatory patient that gets up and uses the bathroom, since heparin is used as a DVT prophlaxsis, I normally talk them out of the shot. Am I wrong for educating my patients on "WHY" they are getting the heparin shot, or should I be talking them into something they don't techincally need. The heparin shots are only given for "DVT prophlaxsis!"

[SnowboardRN]

I was told that if a patient (or person in general) is in bed more than half of the day, then they are indicated for heparin or another VTE prophylaxis. So just getting up and going to the bathroom is not enough to talk them out of it.

We don't have to scan another nurse though. That would probably drive me crazy. We just have to show another nurse the dose and then they cosign at their convenience.

[Vespertinas]

I was told that if a patient (or person in general) is in bed more than half of the day, then they are indicated for heparin...

Shoot then I guess I'm due for shots every other Saturday

[hodgieRN]

I understand what the OP is saying. I get your thinking that if the pt was ambulatory, then why use heparin. The answer is not necessarily about the pts ability to move around, but it depends more on how diseases affect their hematological status. There are a number of factors that can cause DVT like surgery or immobility, pts can clot because of hormone production, stress, infection, sepsis, and newly prescribed medications. Cytokines and other anti-inflammatory pathways can begin a cascade that can lead to clots. Endothelial injuries (which can be caused by hypertension or a decrease in blood flow like anemia) can lead to bad clotting events. Endothelial injury is basically what surgery does...the cutting and manipulation of vessels and tissue. Dead tissue, like an area of necrosis, or even a case of vasculitis from a medication can release factors that initiate the clotting cascade. Mobility is a huge factor with clot prevention, but you can't d/c heparin just because they are walking around. Mobility just helps with prevention, it's not the end-all and be-all of prevention.