colonoscopy, bronchoscopy and bloodthinners

[orangepink, NP]

Hi! I'm a new grad RN in med surg. Have a couple of questions:

- do you withhold bloodthinners such as lovenox on the day of a patient's scheduled colonoscopy? what about with bronchoscopy? and EGD? my understanding is that anything with "-scopy" is just a microscopic viewing of the specified organ so it really doesn't increase the risk of bleeding but if it's a "-scopy" with biopsy then it becomes invasive so I should withhold the bloodthinners, right? should i withhold aspirin too?

- also, is colonoscopy done under general or local anesthesia? what about with bronchoscopy? and EGD?

- and is a laparoscopy done under general anesthesia?

please somebody help me. i'm just so unsure of my clinical judgement.

[creo]

-You should check with the Dr. before withholding any bloodthinners. Usually the Warfarin is withheld 7 days pre procedure. ASA 81mg can be given even the day before the procedure. It really depends on the patient's comorbidities and the Dr' s preferences.

- In our hospital the EGD, colonoscopy, bronchoscpy are done under conscious sedation

- The laparoscopy is done under general anesthesia

[rnmi2004]

Typically we withhold Heparin and Lovenox prior to any invasive procedure. The MD doesn't know ahead of time if a biopsy will be needed. Scopes aren't risk free -- there is always a risk of perforation and in that case, you don't want anything on board that will make managing bleeding from a perf more difficult. If in doubt, check with your facility's policies or ask the MD who will be in charge of the case.

Colonoscopies are typically done under sedation, ranging from light to moderate. Some patients prefer to have them without sedation, but in my experience this is rare. I have seen cases on the OR schedule of colonoscopies under GA, but these are patients who have a very high tolerance to benzos and narcs so basically, the only way they can tolerate a scope is to be completely knocked out.

Laparoscopies are often done under general, but can be done with epidural blocks and moderate sedation.

[diane227, LPN, RN]

All of these procedures are done under conscious sedation. As for holding ASA, heparin etc, it really depends on the doctor but most hold it until they get a normal PT and INR. This is important if they are going to be taking tissue samples. You don't want those patients to have excessive bleeding.