Do you tell pts who get heparin that it comes from pigs???

cruisin_woodward · Mar 23, 2010

okay - so here is the situation: i'm a mid-level with a large nephrology practice - i do dialysis rounding. so...needless to say i order lots of heparin. situation came up that a pt who's been my pt for >2 years asks me if this is pork heparin. i say yes, and he goes off that this is against his religion (muslim) and i should have told him before i gave it to him.

so....my question is: do you guys tell your pts they are receiving pork heparin? btw this is as midwest as it comes. not much cultural diversity and to be honest, it just never occurred to me to ask.

hmmm. wow, i never thought of that! i'm in the midwest too, but work in detroit, where there is a lot of diversity and a lot of muslims. i have never told someone it is from a pig. i've never even thought about it. i am curious as to the responses you get.

talaxandra · Mar 23, 2010

I would tell your patient that you had not thought about the source of the anticoagulant but will notify Muslim and Jewish patients in future. I would also suggest he consult to his Imam.

Bovine-based heparin is no longer manufactured, due to concerns that it had a higher incidence of HITS. It is not possible to safely and efectively perform hemodialysis without using an anticoagulant, so porcine heparin is the only currently available option.

In Judaic law it is possible to break dietary laws (including the prohibition on unclean animals like pigs) to save a life. Islamic law similarly says "necessity legalises prohibitions." In both religions there is an obligation to extend life, so refusing life-saving but dietarily impure interventions is a greater wrong.

Hope that helps :) I'll try to find sources for you

talaxandra · Mar 23, 2010

Where a choice exists, medicines containing alcohol or porcine derivatives (i.e. porcine heparin or alcohol-containing mixtures) should not be used. If an alternate drug is not available then this should be explained to the patient. If the medication is absolutely necessary, then Islam permits its use. (source)

That said, this article looks at heparin alternatives for HD patients.

I'll ask a friend who worked in Saudi on a transplant unit what they did and let you know.

Trauma Columnist · Mar 23, 2010

Thanks so much!

He has refused heparin since then and we just flush with NS.

mammac5 · Mar 24, 2010

We actually were told to ask about a patient's religious and/or cultural beliefs regarding certain meds, heparin being one of them.

Trauma Columnist · Mar 24, 2010

Well, I wish I'd learned that in nursing school. Thanks.

cruisin_woodward · Mar 24, 2010

I posted this question to my fellow nurses, and got the response that 70/30 and protamine sulfate is made from salmon semen...um gross! But the point was that people with fish allergies can have reactions to these drugs as well...It really makes you stop and think. Thank you for bringing this up. I think it's a very important point!

Trauma Columnist · Mar 24, 2010

Wow - I didn't know that about 70/30 and protamine sulfate - thanks for the info.

Medic09, BSN, RN, EMT-P · Apr 2, 2010

None of this is a problem for Jewish patients. I'm having internet trouble posting to the forum; but I'll try to post a more informative answer shortly.

elkpark · Apr 2, 2010

If I had a client who had informed us of dietary restrictions against pork, I would bring up the issue (porcine heparin, or, back in the day, porcine insulin) and see whether it was okay with the client before I gave it.

Medic09, BSN, RN, EMT-P · Apr 2, 2010

If I had a client who had informed us of dietary restrictions against pork, I would bring up the issue (porcine heparin, or, back in the day, porcine insulin) and see whether it was okay with the client before I gave it.

I would certainly agree that is simply the respectful thing to do at any time. But it doesn't hurt to be better informed. Sometimes that allows us to gently encourage the patient or family to more thoroughly consider their options. I had written a bit longer response, but I can't seem to upload more than a few lines.