Heparin and platelets

Is this Iv infusion or sub Q? Either way its good you look at the labs unless you have a doctors order you just can't hold it. Many reasons that the CBC/plt count fluctuate. Always get a order to hold never do it on your own.

Oy, sorry I guess you guys misunderstood. No I am not just holding the heparin and not talking to the doc, yes im refering to SC heparin. I am saying, if I have to give heparin SC in the morning, then I always check the CBC and platelets first. If I notice something off like they are dropping significantly over the last few days or suddenly become super low, I hold the heparin, then ASK THE DOC. Almost in all cases they say yes and will either just monitor labs, or do a HIT panel and they discontinue it, or if they say to continue it, or change it to something else then I give it and carry on. I am not randomly diagnosing my patients with HIT on my own, I am not a physican, but it is something I think about. I am holding it untill I speak with the doc during morning rounds to prevent further harm in case it is, or if the doc wants something different to be given.

Im just saying that I notice people dont take this into consideration and just give it always instead of thinking, hmm, the platelets have dropped, yes it could be many causes but one variable I have is heparin, I think i will hold it and call/talk with the doc and confirm if they want it given. thats all that I was getting at.

Oy, sorry I guess you guys misunderstood. No I am not just holding the heparin and not talking to the doc, yes im refering to SC heparin. I am saying, if I have to give heparin SC in the morning, then I always check the CBC and platelets first. If I notice something off like they are dropping significantly over the last few days or suddenly become super low, I hold the heparin, then ASK THE DOC. Almost in all cases they say yes and will either just monitor labs, or do a HIT panel and they discontinue it, or if they say to continue it, or change it to something else then I give it and carry on. I am not randomly diagnosing my patients with HIT on my own, I am not a physican, but it is something I think about. I am holding it untill I speak with the doc during morning rounds to prevent further harm in case it is, or if the doc wants something different to be given.

Im just saying that I notice people dont take this into consideration and just give it always instead of thinking, hmm, the platelets have dropped, yes it could be many causes but one variable I have is heparin, I think i will hold it and call/talk with the doc and confirm if they want it given. thats all that I was getting at.

Sounds like you are being a responsible nurse and critically thinking about your patient. Some people do and some people don't. If you are concerned however you could always ask for a parameter from the MD if you feel the patient is at risk. Or perhaps this is a policy change your facility could look at as Evidence-Based Practice?

We are required to check the platelet levels before giving Lovenox. If the value is under 100,000 or has dropped 25% since the last labs were taken we have to consult the physician. We don't give heparin very often, but I'd do the same thing.

I always check my patient's CBC prior to giving SC Heparin but it has to be really low for our docs to hold it. I agree with a PP, you are thinking critically and if it is held even once because you thought to look at their labs then I'd say you're doing a good job.

I also agree that you need to be aware of what you are giving and the side-effects of it. It is responsible to ask the doc before giving a med if you have a concern. Our policy states to hold heparin if plts drop to under 100,000 or by more than 50% from baseline. But we also still discuss with MD. It is the same thing as checking before giving Lasix if renal labs are worsening and pt has a low BP. If in doubt, ask.