this did not make sense to me.

[turnforthenurse, MSN, NP]

Recently, I took care of a patient post-cardiac cath. Patient had groin site in addition to TR band. No interventions were done because of the amount of blockage, so the cardiologist wanted to try again using a different approach via the popliteal artery. Patient was still on bed rest when I came on shift.

Early that evening, a doctor calls me and said they were putting in orders for a heparin gtt to be started at 2200. I questioned it because no interventions were done AND the patient's platelets were already low (@ 65) and all they said was "it is a therapeutic dose."

The patient couldn't keep their leg straight, so there was some bleeding at the site. VSS, site was soft, CMS checks were at baseline. I notified the cardiologist, who stated the bleeding was fine, and stated he still wanted the patient on the heparin gtt

So I start the gtt per protocol. I kept a watchful eye on that patient. No changes. AM labs were drawn, heparin assay was therapeutic so I didn't have to make any changes, but the platelets were now @ 50. I remember reading the cardiologist's procedure report stating that if plts

Again, no more bleeding from site, CMS checks at baseline, VSS. I documented everything the docs said verbatim. I'm not even sure what happened after I left because for whatever reason the patient was transferred to med-surg, still on the gtt (because it was before 1200).

Did their rationale make sense to you? Because it didn't make any sense to me, and I thought there could have been a potential for adverse effects. Someone help me understand because the docs just kind of brushed it off!

[stillstrugglingrn]

Sounds like this pt had some pretty bad blockages. I geuss the MD thought the benefits outweighed the risks. You sound like you did everything possible to CYA. I do find it incredibly strange that they would send this patient to a med-surge floor though.

[turnforthenurse, MSN, NP]

I thought so, too! Because the patient would end up back on my floor, or in ICU. I didn't see them again after that.

[psu_213, BSN, RN]

To me, the strange part in the transfer to med surg, not the heparin gtt. If he had diffuse blockages, the will anticoagulate him. The plt count needs to be watched, but at present, the blockages (and making sure they don't increase in size) takes the priority over the low plts. Just be sure to chart all your calls to the doctor and what was said.

[turnforthenurse, MSN, NP]

To me, the strange part in the transfer to med surg, not the heparin gtt. If he had diffuse blockages, the will anticoagulate him. The plt count needs to be watched, but at present, the blockages (and making sure they don't increase in size) takes the priority over the low plts. Just be sure to chart all your calls to the doctor and what was said.

Yeah I guess that makes sense, I just thought it was weird having a low platelet count and all, and the patient bled at the cath site. I charted everything verbatim when I made calls to the doc to cover my butt.

[Esme12, ASN, BSN, RN]

Just one of those benefit versus risk scenario. Sounds like this patient has diffuse disease and requires then blood to be as "thin as possible". Without knowing the rest of the history it is difficult to say why he continues with the low platelet count.

[simonemyheart]

I like this post!!! I feel like I am learning right along with ya :)

[turnforthenurse, MSN, NP]

Just one of those benefit versus risk scenario. Sounds like this patient has diffuse disease and requires then blood to be as "thin as possible". Without knowing the rest of the history it is difficult to say why he continues with the low platelet count.

The patient's only history was PVD and history of low platelets, but they never figured out why

[Esme12, ASN, BSN, RN]

Well it till goes that the PVD is so bad that they are trying to keep the blood thin enough to flow through those clogged arteries until they can perform an intervention.

[Creamsoda, ASN, RN]

Well I'm assuming that since he already had low platelets, like other said, risk vs benefits...they can watch the platelets. If there was a sudden drop from the low baseline, then they would probably stop it and look at HIT labs, but if it was low/stable, just monitor the patient. But I do also question the transfer to med/surg with diffuse cardiac disease and on heparin with a high bleeding risk. Seems strange.

[PetERNurse]

Even though your platelets are 65 or 50, they are still capable of forming a thrombus. This is why the doc ordered the hep drip. Heparin is not a "blood thinner", and does not decrease the viscosity of blood improving arterial flow. IT DOES potentiate ATIII causing increased binding to thrombin, decreasing the amount of thrombin available to form a clot, increasing coag times. While there may be less platelets circulating, you still need to anticoagulate the patient to prevent further blockages. Heparin will cause an initial drop in platelets, but they recover after discontinuation.

[MomRN0913]

The heparin gtt makes sense, but the rest doesn't.

Multiple severe bloackages sounds like patient should have been going for CABG. Not making another attempt in the poplital artery. Why could the patient not have interventions through the other sites?

And a medsurg floor? A few things don't add up here.....