cardiac cath nurses

[baju]

Hi everyone,

I'm a new tele nurse for few months now. I've been sending patients to cardiac cath and the protocol at our hospital is to give aspirin and plavix prior to the procedure. In nursing school, prof taught us not to give "blood thinners" to patients prior to a cardiac cath procedure. Any reason for this? Thanks guys!

[HouTx, BSN, MSN, EdD]

Probably for the same reason that they are held prior to most invasive procedures.... danger of excessive bleeding. This is particularly worrisome if the 'leak' will be in a vessel/area that cannot be easily accessed to stem the flow. New developments in technology & methodology have made cardiac cath much safer. The most common complication is post-procedural bleeding at the insertion site which is normally controllable with adequate compression after sheath removal. There is also a slight danger of clot formation @ the sheath apparatus, so many docs like to 'let 'er fly' with blood flow immediately after removing the sheath in order to expel clots prior to compression of the site ... keep those towels ready!

[nurseprnRN, BSN, RN]

Many people including, alas, physicians and nurses who know better, refer to anticoagulation medications (both antiplatelet and those acting on other parts of the clotting cascade) as "blood thinners." Unfortunately, and inaccurately, this puts people (and, alas, some nurses) in mind of paint thinned by solvents or watered-down milk, or maybe thin, inadequate clothing. The problem then becomes that they are not aware of the actual physiological reason their medications are prescribed to reduce risk for embolic events, either stroke or deep vein thrombosis and pulmonary embolus. I have had patients tell me they are "always cold since taking that blood thinner." The risk of discontinuing the medication because the effects are inaccurately communicated is great, and very real. Anticoagulants do not "thin" the blood. They decrease blood clotting to decrease the chances of a clot in the heart from causing stroke or clot in a vein traveling to the lungs by preventing it from growing larger while the body's natural processes break it down for disposal. Side effects include easier bruising and bleeding. There, is that so hard?

[Anna Flaxis, BSN, RN]

Hi everyone,

I'm a new tele nurse for few months now. I've been sending patients to cardiac cath and the protocol at our hospital is to give aspirin and plavix prior to the procedure. In nursing school, prof taught us not to give "blood thinners" to patients prior to a cardiac cath procedure. Any reason for this? Thanks guys!

The patient undergoing PCI is at risk for an embolic event r/t the invasive nature of the PCI and the body's natural response to it, i.e. wanting to clot. It's been a while since I worked tele, but people got Angiomax or heparin intraprocedurally all the time. With heparin, we'd do a bedside aPTT prior to sheath removal, and with the Angiomax, sheath removal was based upon the time the gtt was stopped. ASA and Plavix will not prevent you from achieving hemostasis on sheath removal; the blood does eventually clot. However, good sheath removal technique in order to avoid bleeding complications such as hematoma, thrombosis, and dissection is important.