DDAVP administration with fresh hearts

[tigerita]

I'm curious if anyone can give me some feedback on your hospital's policy with fresh hearts. I recently switched hospitals and am noticing a trend with post-op hearts and profuse bleeding. It's not uncommon to give at least a couple units ffp or prbc emergently or even to send pts back to surgery at my new hospital, while I never had this issue at my old hospital. One difference I have noticed is that previously at my old hospital every fresh heart got a DDAVP ivpb that usually was just finishing as we received them in ICU.

My question is, do your surgeons administer DDAVP on your hearts? I know the literature is sketchy on whether it decreases bleeding post-op or just intra-op but depending on what info I can get I may bring it up as a possible change in our routine (even though I realize it's totally dependent on what the docs think). Let me know!

[Rose_Queen, BSN, MSN, RN]

My facility does not routinely give intraop DDAVP- in fact, in my time as an open heart surgery nurse, I've used it maybe 3 or 4 times. However, we are using thromboelastography from blood drawn following cardiopulmonary bypass separation. In situations where the surgeon may have ordered platelets and/or FFP right off the bat, we are now looking at the results and have a protocol for what should be given (if anything) based on the results.

[MunoRN, RN]

We give Amicar, it's my understanding that there is no evidence to support the use of DDAVP for this purpose. In my experience it's seemed like the difference in the rate of bleeders is more related to the type of patients they offer surgery to, and maybe a little bit of physician competence level.

[StayLost, BSN, RN]

We routinely use Amicar as well. If there are problems with bleeding, it's not uncommon for our patients to receive DDAVP in the OR.

[BlueChocolateCat]

Amicar is routinely used by only certain surgeons at my location. I have only seen it handfull of times. As a facility, we do not routinely use either.

[dah doh, BSN, RN]

Amicar for our hearts if needed.

[**LaurelRN, MSN]

Our hearts routinely come out with Amicar. DDAVP is kinda a last resort- if bleeding doesn't stop with FFP and Plt's, they'll go to cryo, then DDAVP- if it doesn't stop then- they go back to OR

[SubSippi]

We use Amicar where I work, too. We will give platelets as the next step, but if that doesn't work the patient will go back to the OR.

Maybe it has something to do with the way the perfusionists operate. Or, like the PP said, it could be the patient population. Are you working at a bigger hospital now?