Do you tell pts who get heparin that it comes from pigs???

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  1. This is a discussion on Do you tell pts who get heparin that it comes from pigs??? in Nurse Practitioners (NP), part of Advanced Practice Nursing ... okay - so here is the situation: i'm a mid-level with a large nephrology practice - i do dialysis...

    by Admin Mar 23, '10
    okay - so here is the situation: i'm a mid-level with a large nephrology practice - i do dialysis rounding. so...needless to say i order lots of heparin. situation came up that a pt who's been my pt for >2 years asks me if this is pork heparin. i say yes, and he goes off that this is against his religion (muslim) and i should have told him before i gave it to him.

    so....my question is: do you guys tell your pts they are receiving pork heparin? btw this is as midwest as it comes. not much cultural diversity and to be honest, it just never occurred to me to ask.
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    by traumaRUs Mar 23, '10 12:42 pm
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  3. 22 Comments so far...

  4. Mar 23, '10 by
    Quote from traumarus
    okay - so here is the situation: i'm a mid-level with a large nephrology practice - i do dialysis rounding. so...needless to say i order lots of heparin. situation came up that a pt who's been my pt for >2 years asks me if this is pork heparin. i say yes, and he goes off that this is against his religion (muslim) and i should have told him before i gave it to him.

    so....my question is: do you guys tell your pts they are receiving pork heparin? btw this is as midwest as it comes. not much cultural diversity and to be honest, it just never occurred to me to ask.
    hmmm. wow, i never thought of that! i'm in the midwest too, but work in detroit, where there is a lot of diversity and a lot of muslims. i have never told someone it is from a pig. i've never even thought about it. i am curious as to the responses you get.
    Last edit by TheCommuter on Mar 23, '10 : Reason: added quote blocks
  5. Mar 23, '10 by
    I would tell your patient that you had not thought about the source of the anticoagulant but will notify Muslim and Jewish patients in future. I would also suggest he consult to his Imam.

    Bovine-based heparin is no longer manufactured, due to concerns that it had a higher incidence of HITS. It is not possible to safely and efectively perform hemodialysis without using an anticoagulant, so porcine heparin is the only currently available option.

    In Judaic law it is possible to break dietary laws (including the prohibition on unclean animals like pigs) to save a life. Islamic law similarly says "necessity legalises prohibitions." In both religions there is an obligation to extend life, so refusing life-saving but dietarily impure interventions is a greater wrong.

    Hope that helps I'll try to find sources for you
    Spidey's mom, MissDoodaw, and Purple_Scrubs like this.
  6. Mar 23, '10 by
    Where a choice exists, medicines containing alcohol or porcine derivatives (i.e. porcine heparin or alcohol-containing mixtures) should not be used. If an alternate drug is not available then this should be explained to the patient. If the medication is absolutely necessary, then Islam permits its use. (source)
    That said, this article looks at heparin alternatives for HD patients.

    I'll ask a friend who worked in Saudi on a transplant unit what they did and let you know.
  7. Admin
    Mar 23, '10 by
    Thanks so much!

    He has refused heparin since then and we just flush with NS.
  8. Mar 23, '10 by
    We actually were told to ask about a patient's religious and/or cultural beliefs regarding certain meds, heparin being one of them.
  9. Admin
    Mar 23, '10 by
    Well, I wish I'd learned that in nursing school. Thanks.
    MUUGUZI likes this.
  10. Mar 23, '10 by
    I posted this question to my fellow nurses, and got the response that 70/30 and protamine sulfate is made from salmon semen...um gross! But the point was that people with fish allergies can have reactions to these drugs as well...It really makes you stop and think. Thank you for bringing this up. I think it's a very important point!
  11. Admin
    Mar 24, '10 by
    Wow - I didn't know that about 70/30 and protamine sulfate - thanks for the info.
  12. Apr 1, '10 by
    None of this is a problem for Jewish patients. I'm having internet trouble posting to the forum; but I'll try to post a more informative answer shortly.
    traumaRUs likes this.