heparin or lovenox 24 hours before surgery?

[pecantreechipmunk]

Hi allnurses

I just came up with a question about pre-op blood thinner.

Generally if I have a patient going to surgery in 24 hours. I asked patients if they want it or not so I can put it as patient declined.

My question is is it generally okay to hold off regularly scheduled blood thinner without asking patients' opinion? unless it is specifically described to give by surgeon?

It seems like it is quite a common sense to hold off blood thinner in 24 hour pre-op.

 

[CalicoKitty, BSN, MSN, RN]

Lovenox is the long-acting version, so 24 hours would be a more appropriate hold time. But, Heparin is given 3 times daily since it's half-life is much shorter (so 24 hours would be a bit long to hold it). They are also "reversible" if a bleeding problem arises - either reversing with protamine or giving a blood (or blood product) treatment. Clots are a usually harder to treat.

I think clarifying with the surgeon would be a good idea (and it would be great if they did something like put the medications on hold if they don't want them given). It may also matter what type of surgery - a foot surgery would have different risks than an open abdomen. I also believe heparin is given preop for some patients/surgeons.

[JKL33]

6 hours ago, pecantreechipmunk said:

Generally if I have a patient going to surgery in 24 hours. I asked patients if they want it or not so I can put it as patient declined.

Regardless of the nuances that might be described about why the patient should or shouldn't have a certain medication held pre-op depending upon their individual circumstances, this ^ is unethical. It is an abdication of your responsibilities as a nurse. I'm a little appalled you would do this instead of just finding out the rationale for the orders and making sure everyone is on the same page about the upcoming surgery. If the medical care team doesn't want the patient to have the medication at that time, they will tell you to hold it and enter an order to hold it.

What if they do want the patient to have the medication in question and instead you have taken this route of 1) not knowing 2) not being able to give the patient relevant information and 3) letting the patient casually make a decision that is not in their best interest?

This is not how nurses operate. In this situation you have not described doing a single thing that a nurse should do.

 

6 hours ago, pecantreechipmunk said:

My question is is it generally okay to hold off regularly scheduled blood thinner without asking patients' opinion? unless it is specifically described to give by surgeon?

It isn't okay for you to decide what you think might be best based on your limited knowledge or your idea of common sense.

It is also your professional role to educate patients so that, if able, they can participate in their plan of care and they understand why things are happening.

[Rose_Queen, BSN, MSN, RN]

There are actually Enhanced Recovery After Surgery (ERAS) guidelines that include giving anticoagulants immediately preop. Believe me, there is a lot of thought put into guidelines for continuing/changing/holding ACs before surgery. The patient does NOT have the knowledge to make that decision, and the fact that you are asking the patient rather than the surgeon or attending is appalling practice. 

[Val_998, BSN, RN]

9 hours ago, JKL33 said:

Regardless of the nuances that might be described about why the patient should or shouldn't have a certain medication held pre-op depending upon their individual circumstances, this ^ is unethical. It is an abdication of your responsibilities as a nurse. I'm a little appalled you would do this instead of just finding out the rationale for the orders and making sure everyone is on the same page about the upcoming surgery. If the medical care team doesn't want the patient to have the medication at that time, they will tell you to hold it and enter an order to hold it.

What if they do want the patient to have the medication in question and instead you have taken this route of 1) not knowing 2) not being able to give the patient relevant information and 3) letting the patient casually make a decision that is not in their best interest?

This is not how nurses operate. In this situation you have not described doing a single thing that a nurse should do.

 

It isn't okay for you to decide what you think might be best based on your limited knowledge or your idea of common sense.

It is also your professional role to educate patients so that, if able, they can participate in their plan of care and they understand why things are happening.

Perfect answer. The thought process is concerning.