Just a quick question to see if I did the right thing with heparinization of a patient with stroke. This am lab draw ptt was 135.9 heparin shut off for one hour next blood draw at 1330. Results called to our floor stating ptt was greater than 212 (huh) ok so I shut it off and requested the lab draw it again. somewhere today I had heard that their values may have been off. Well anyway gave report and told the girls what was going on and that i requested the lab do another blood draw, they said ok they would look out for the results. I get a call from the supervisor stating why did I get another blood draw and why wasn't the heparin restarted at 1530 ........ I explained to her the situation and all she kept asking was why why. Then I asked her what his value was and she said it was down, didn't give me specifics. So who was in the right. I told the next shift coming on so where was this my problem when my shift ended at 1530? Just wanted some peace of mind.
Mar 1, '04
I hate, hate, hate when the next shift doesn't cover for you when you ask them to. If they had a problem with it they should have addressed it right then and there.
Personally, I would have redrawn the specimen if there was any doubt it was a false high. However, I would have followed the protocol based on the result I had, turned it off for an hour, made the rate adjustment, turned it back and asked the next shift to keep an eye out for the result. Who knows how long the next shift left it off, or when the lab results came back.
But you know if you had followed protocol and the lab came back high, they would have been calling you asking why why why did you turn it back on. Can't win for loosing.
I hope the supervisor uses it as a learning experience and not to make you feel bad. Follow hospital protocol and you can't loose. Bottom line, you weren't covered by protocol or an MD order to leave the heparin off. Common sense told you to leave it off, but in the end they can prove you in the wrong.
Mar 1, '04
It sounds like you did everything I would of done.May I ask if you have a heparin protocol? If not , May I ask if you informed the neurologist each time and if you obtained a verbal order to hold the heparin? I definitly would of held the heparin, repeated the ptt a 2nd time and in the mean time if there were no heparin protocols ( my hospital doesn't have one) I would have called the neurologist to obtain another order to hold the heparin for another specified amount of time and to report the PTT results , and charted all this in my notes. Hope this helps and good luck ...Denise
Last edit by deniseS on Mar 1, '04
Mar 1, '04
I am a little confused as to what actually happened in your case.
Here is what we do in our facility. If PTT >150 stop heparin and restart in 1 hour. Decrease Heparin by 3 units per kilogram per hour. Recheck PTT in 6 hours. If PTT greater than >150 again, you may want to consider consulting the ordering doc. Definately assess the patient for any signs of bleeding or neurological changes while on heparin. Especially that high.
One thing to consider, when lab drew your patient, did they draw off the same arm the heparin was infusing in?
Hope this helps.
Mar 1, '04
Quote from deniseS
It sounds like you did everything I would of done. May I ask if you informed the physicain each time and if you obtained a verbal order to hold the heparin? I definitly would of held the heparin, confirmed with the physician an order to repeat the ptt a 2nd time and an obtained another order to hold the heparin for another specified amount of time as per the neurologist, and charted all this in my notes. Hope this helps....Denise
Sounds like she was following a standing order for a heparin protocol. You don't need to call the doc each and every time you make an adjustment. Just follow the protocol. The stroke protocol at our hospital is similar to the one stated above, hold for one hour and adjust the rate downward, then followup in six more hours with another ptt.
She however, had a strong suspicion that she had a false reading and wanted to recheck it. It gets a little shady here as there are no orders what do if you have a suspected false reading.
Mar 1, '04
I'll explain a little better we do have a heparin protocol and the results indicated for the heparin to be shut off amt of infusion decreased by the said amt per kilogram and restared in one hour with a ptt in 6 hours. I did not take notice if the blood was drawn in the anicub above the iv site with the heparin infusing or not but I did right by stopping the heparin at around 1430. Told the oncoming shift of the problem with the results. The lab obtained another speicmen at 1510 and results back around 1550 (which according to supervisor was decreased from previous result)after I had already left so in any event the patient was only with out heparin for 20 minutes which I don't think could have affected him in the least bit. Still fuming :angryfire
Mar 2, '04
For anyone following this I checked what yesterday afternoon's 1500 lab draw to see what the result was and you will never believe it....... Ready, 62, I feel like having a party and dancing all around the supervisor,saying I told you so...... Ptt this am therapeutic. Tap on the back need for me
So that meant either the lab drew from above the site or their machines are way off because he could not have have gone from above 212 to 62 with the heparin turned off for 1/2 hr.
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