cranberry juice and ptt

[buddiage]

I had a pt who was on a heparin drip, and I followed protocol to titrate based on ptt levels. Well, her ptt came back >200 multiple times between me and another nurse (protocol- stop infusion one hour, then restart and lower by 250). I found the heparin dc'd after two docs worked it out (per report at change of shift) and there was mention of cranberry juice causing the problem. My pt drank quite a bit of cranberry juice.

Anybody heard it?

[JBizzleRN, ADN, RN]

I don't know...I did have a patient drink Cranberry juice and her HCT came up like 3 points..she even said it would before she started drinking it.

[iluvivt, BSN, RN]

I bet the specimen was taken from above the IV site or near it or from a CVC and was done incorrectly or the discard was used instead of the intended specimen b/c I have never personally seen this. What did your repeat draw show..that will give a clue as to the cause?

[JBizzleRN, ADN, RN]

The first was 26.7 and the repeat was 29.1 I believe was the numbers. But no it was not drawn incorrectly. I drew it from the arm opposite the IV. One doctor told me that it's actually normal for H&H's to vary like this...even drawn a few minutes apart.

[cherrybreeze, ADN, RN]

I know it comes up automatically that a patient cannot have cranberry products while on Coumadin on our patient profiles. I thought about this just the other day, though....most "cranberry juice" is actually cranberry juice cocktail, especially in a hospital with a bulk supply, and it contains very little ACTUAL cranberry. I can't imagine they drank that much of it to make a difference in this case, esp when the PTT can change so rapidly with a hep gtt. It seems pretty silly IMO actually to blame something OTHER than the drip?

[britgirl37]

I read an article on this about 2 yrs ago in Nursing Standard (british nursing journal) and yes, apparently out there somewhere is evidence that cranberry juice can affect the ptt. Can't remember the details, but I do believe a pt died in UK due to high ptt after drinking a lot of cranberry juice. Can't imagine just how much it would take to do this though, like I said, I can't remember the details.

[morte, LPN, LVN]

a quick, one page search, only comes up with the relationship to warfarin

[Twilmott]

I had never heard of cranberry juice effecting PT/INR's until today. So I did some searching on the internet to find more info. It seems that there is no concrete evidence that cranberry juice effects it at all unless consumed in large quantities like 24oz-1gal/day. There was one case where a man had been on 13mg/wk of coumadin for 9 months w/INR's ranging between 2.5-3.5. Then his INR was 6.9 and the only thing that had changed was that he was drinking 1 gal/day of cranberry juice they had him cut back on the juice and rechecked in 2 weeks. His INR was then 4.3 and he was drinking 1/2gal/day. I know some medical professionals teach to avoid foods w/Vit K when on Coumadin but I have always taught that pts should keep a consistent amt in their diets, so that it what I will do now re:cranberry juice - consistent low amt.

[BluegrassRN]

I also think people are getting more savvy in their consumption of foods. Many consumers know that cranberry juice cocktail is just that--a little juice, a lot of sugar. But in most places, pure cranberry juice is available, people know to look for it, and a lot of people consume that for bladder infections.