I need some nursing knowledge shares please-new nurse

AKSkier · Jul 2, 2009

I do not work dialysis, so not sure about lovenox and dialysis.

As far as the SCD and lovenox, I would not leave the SCDs off. They work together to prevent DVTs. Especially if the patient had surgery, I am used to using both. If the doctor has ordered both you need to use both. In fact, I am used to using TED hose, SCDs and lovenox on post op patients. Of course, you need to take the SCDs off when ambulating and you can leave them off usually while the patient is in the chair. But when they return to bed they need to be on.

nursealanarae · Jul 2, 2009

I would definately call the doctor for the lovenox order and then follow-up with the dialysis nurse, although I don't think it would be bad to give it. I would never put any kind of compression stockings or device on an extremity that had open ulcers. That is just not a good idea.

PostOpPrincess, BSN, RN · Jul 2, 2009

What is your hospital standard of care? THAT'S where you need to find this answer.

SummerGarden, BSN, MSN, RN · Jul 2, 2009

What is your hospital standard of care? THAT'S where you need to find this answer.

:yeahthat:Protocol, protocol, protocol!!!

OP and anyone esle who reads: I'm a new nurse too... please join us on the First Year After Nursing Licensure forum even if you have 1 year under your belt. :) https://allnurses.com/first-year-after/

CaLLaCoDe, BSN, RN · Jul 2, 2009

enoxaparin has not been fda approved for use in dialysis patients. it's elimination is primarily via the renal route. serious bleeding complications have been reported with use in patients who are dialysis dependent or have severe renal failure.

information found on the net at:http://www.globalrph.com/enoxaparin_renal.htm

Virgo_RN, BSN, RN · Jul 2, 2009

I have two quetstions:
1. Can you give dialysis patients lovenox for dvt prevention?
2. Would you place SCD's on a patient who had diabetic ulcers on their lower legs with dressings?
ok maybe one more question---
3. if a patient is receiving lovenox for dvt prevention, can you leave the scd's off?

1. A patient on hemodialysis would be at an increased risk of hemorrhage due to the fact that enoxaparin is renally excreted. However, people with ESRD are at risk for developing DVT, so yes, often unfractionated heparin or LMWH are utilized in this patient population. You just have to be vigilant for any signs of blood loss, both external and internal. Risk for bleeding would be a priority nursing diagnosis for these patients.

2. I would think this would be incredibly uncomfortable, and might ask if Plexipulses would be a better option for this patient.

3. No. Lovenox and SCDs work together. Remember Virchow's Triad (Endothelial injury, venous stasis, and hypercoagulability). These each work on two different aspects of the triad; venous stasis (SCDs) and hypercoagulability (Lovenox). The third aspect, endothelial injury, would be something like keeping blood pressure under control.

nursealanarae · Jul 2, 2009

enoxaparin has not been fda approved for use in dialysis patients. it's elimination is primarily via the renal route. serious bleeding complications have been reported with use in patients who are dialysis dependent or have severe renal failure.
information found on the net at:http://www.globalrph.com/enoxaparin_renal.htm

i am glad you found this out! i have limited experience with dialysis patients, so it is good to know!

but, yes. always look at protocol.

2. i wouldn't put scd's on open wounds, even if they are covered by a dsg. encourage ankle pumps! see if there are other methods this patient could have for dvt prevention.

3. i would definately out the scd's on even if the patient is taking lovenox. they work together.