heparin drip and ptt
- 0Oct 10, '09 by sdwmbwhile on the unit we had a discussion concerning heparin drips and drawing a ptt. I would like to hear what others do or what their hospital policy is. We tried to look up a policy and couldnt find one. Pt is receiving heparin drip via peripheral site. Can't stick the other arm due to a fistula, have to get the ptt out of the arm with the heparin drip. the general consenus was if draw above the IV turn off heparin for a few min before v/p if drawing below the IV is where people were not in agreement turn off the IV or no?
- 1Oct 10, '09 by Angie O'Plasty, RNMight be a good idea to call pharmacy or the lab to ask if they know the hospital policy. Or ask the house supervisor where to find your hospital policy.
Our policy called for turning the drip off for a few minutes prior to a peripheral draw. I know because the lab techs couldn't turn off the pump and had to ask me, then follow up and let me know when the draw was done so I could turn the pump back on.
- 0Oct 10, '09 by ChineseRNOur hospital policy is no blood draw from the peripheral line that is receiving heparin drip. If the pt has an A/V shunt or mastectomy on the other arm, then we cannot use either arm. Then, the MD would have to draw coags from the leg. Nurses are not allowed to draw anywhere but the arms.
- 1Oct 10, '09 by musikloverOur hospital policy states that the heparin gtt must be turned off for ptts from the same extremity. The only reason that I know that (as someone else posted) is because I've had phlebotomists come to me to turn off hep gtts so they can come back and do the lab draws after the gtt has been off for 5 or 10 minutes. They then come back and tell me after they've drawn the labs so that I can come in and restart the gtt.
- 0Oct 11, '09 by nrsgnerdFirst of all you can call the lab and ask them, or better yet the physician who should be well versed and able to help you.
Do you have a heparin protocol? We do in our CCU, and we draw an AntiXa which is more specific to see if heparin therapy is at a therapeutic level and we draw this while the heparin is running and titrate the drip according to what the protocol calls for. If your not in a CCU but have a CCU/ICU/CVICU then call and ask the nurses there what they do. Regardless, if you turn the heparin off you may not get a true PTT because heparin clears the body pretty quickly. I know that when we are going to pull a sheath on a cath lab pt, we turn the heparin off for 90 minutes then draw an ACT (clotting time) and if its less than 180secs then its consider safe to pull the sheath out and hold pressure for 25 minutes.
The bottom line is that you want to know that you are not overcoagulating the pt. so turning off the heparin before drawing will skew the PTT and put you at risk of over coagulating the pt. Hope this helps!!