LOVENOX before procedure

[Nurse123456789]

Hypothetically:

Patient admitted at night for Covid 19 and osteomyelitis.  Morning meds include lovenox and ASA ordered by night hospitalist. Day nurse gives meds ~0830. Podiatry comes, does beside I&D and is undecided on bringing to OR. Decision made to bring pt to OR ~1700. Pt does have increased bleeding intraop. 

1. Should the pt have been brought to OR that day even though pt received lovenox and ASA in the am? Does the emergent nature outweigh the risk? Does the surgeon consider this prior?  Is it the surgeons responsibility to review all this? 

2. Pt was brought to OR with bleeding complication intraop. Who does it ultimately fall on? Ordering provider? Surgeon? Nurse? Yes, maybe nurse should of held morning meds, but surgery decision was not established until later in day.

3. If unsure, better to hold meds and give late? What if there is no communication between nurse and doctor? It seems morning meds are given prior to having a set plan. And depending on plan, meds given may alter it. 

4. Any experience on anti coags/plts and same day surgery? Easily correctable? Protamine? PLTs? 

 

[Rose_Queen, BSN, MSN, RN]

4. There are some standards for surgery that actually indicate giving heparin prior to surgery. We do as part of ERAS for colon surgery. Coagulopathies can be reversed IF indicated. 

Cannot speculate on the other questions. 

[DavidFR, BSN, MSN, RN]

If an anticoagulant or an anti-platelet drug has been given and then the patient needs an invasive procedure, a full blood count and clotting screen can be drawn as an emergency sample pre-op. Some patients subsequently have the perocedure done under cover of platelets, vitamin K or Tranexamic acid as appropriate.

As the above poster points out, some procedures actually require pre-op anticoagulation to avoid the risk of clots developing on the table.

Often it boils down to doctor's preference. Some don't care and yet others go OTT (I am personally on aspirin 160mg per day and was told to stop my aspirin THREE DAYS before a minor dermatology procedure).

To answer your final question, yes, it is the surgical team's (or in some countries, anaesthetist's) responsibility to check these things out. If in doubt you can always verify with the doctor, "He had Lovenox 0.4 this this morning, is that OK?"

[JKL33]

7 hours ago, Nurse123456789 said:

Does the surgeon consider this prior? 

Yes.

7 hours ago, Nurse123456789 said:

Who does it ultimately fall on?

Consider that there might not be anything to fall on anybody. There isn't a single right answer for every patient situation.

7 hours ago, Nurse123456789 said:

Yes, maybe nurse should of held morning meds, but surgery decision was not established until later in day.

Why would the nurse have held the med then?

7 hours ago, Nurse123456789 said:

If unsure, better to hold meds and give late?

If unsure it is better to consult with the involved providers who are directing the patient's medical plan of care.

 

[canoehead, BSN, RN]

It's the docs call whether safety for surgery has been maximized. Nursing can do a lot, but we cant read the future.