Heparin Bolus Contraindications

[newgradrn2011]

Looking for rationale for holding the heparin bolus at the start of Tx for systolic above 200 and other contraindications. And heparin infusion for caths and contraindications.

New grad rn with 5 wk classroom training and in 5th wk pct training under PCT Lead Tech (will post another thread RE training with preceptor who holds back information/makes the training process more difficult than necessary/gives me all of the most diff pts/follows no organized training program...today was supposed to be my last day under her, but I asked the nurse manager and for one more week taking off pts and cannulation b/c she just introduced this to me last Wednesday and I would have only had 7 days of practice before I begin RN training portion...but I digress).

This came up at the beginning of am shift as I had just set up 4 machines and partially put on two pts that she stated were buttonhole (only 1 was), then she gave me a machine to set up, take vitals, imput info, and place the needles, mind you I told her 3x that the pt B/P was elevated, and then I called the RN for the heparin bolus. She gave it. 5 min later, the preceptor pulled me asside and stated that the pt had an elevated B/P and that as an RN I should have known that, and I should have held the bolus.

I felt like I had been set up, and pulled her aside at the end of my shift to talk to her about it ... she denied knowledge of my information, and stated that the RN told her because she was on the other side of our 26pt unit, and then she told me. This is when I told her to give me another week cannulating, starting and taking off pts. She told me to ask our charge nurse, and she gave me one more week.

I have looked through co policy and my classroom training worksheets, and only come up with this:

Tell patient the purpose of the drug

and assess the patient for recent

events that would be a

contraindication to Heparin, such as:

recent falls or injury, unusual

bruising, eye or nose bleeds, bloody

stools, recent (within days) surgical or

dental procedures. If these events

have occurred, withhold the heparin

& contact the physician to determine

Heparin orders for that treatment.

Sorry for the long post (my first) and I appreciate any information that you can give me. I am new, but willing to learn and improve my assessment skills..and watch my back.

new2nursing@45

[RNewbie]

I have no exp with dialysis but was interested in learning more about your concern as posted above. It seems like there is no true standard set in stone. Seems like the thought behind holding the heparin with high BP is related to the risk of cerebral hem in the event of a stroke. I guess you would have to weigh the risks vs the benefits. There should definitely be something in your policy and procedures regarding this if there's not. Maybe you can get some meaningful info from research articles on this issue.

Anywho, found this link:

https://allnurses.com/general-nursing-discussion/stopping-heparin-infusion-450782.html

[Tish88]

First of all, I have to say you did the correct thing to look in your policy and procedures for the answer. As you posted, there is no company policy about given heparin with a SBP 200.

I have MANY patients that come in with BP's higher than that and I give the heparin.

The patients blood pressure will come down with treatment. The high BP is usually in correlation with the excessive fluid in the vascular system that will be removed with dialysis.

So, what was the rational the tech gave you about not giving the heparin????

Lastly, the RN gave the heparin. They would have looked at the vitals and machine settings during this time, so there did not seem to be any problem.

What was the patients standing/sitting pre treatment blood pressure? Is this their norm? Do they have a MD order not to give if SBP >200????

[traumaRUs, MSN, APRN]

agree with tish and your policy manual. No reason not to give heparin.

[just keep swimming]

I would assume the reason to hold heparin would be due to the risk of hemmorhagic stroke with elevated BP's. That being said, in my 7 years in HD, I have never held heparin for this reason. As said above, this HTN is usually due to extra fluid and is usually the patients baseline. If I had any other indications that the patient could be having a stroke, not only would I withhold heparin, but I would send the pt to the ER. Sounds like this is something you should talk to the RN about, not the PCT. Many times the PCT's follow directions without educating themselves on why they are doing what they are doing. Remember that ultimately, our education is our responsibility! Good luck!