this did not make sense to me.

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.

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.

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.

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.

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

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

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.

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.

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.....

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.....

Perhaps the blockages aren't in the coronary arteries, perhaps this is a peripheral case. Or, the blockages in the fem area prevented a fem approach, hence the initial radial approach. Or perhaps this pt is obese and a fem approach isn't the best way, and we go with popliteal.I could probably come up with 10 more reasons why the popliteal art approach sounds perfectly acceptable. We did it all the time in my previous lab..

Multiple, severe blockages doesn't always mean cabg, and doesn't always mean CAD. Plenty of arteries in the body to become blocked. And fixing it in the CCL is a way better approach (sometimes....most times) than vascular surgery..not everyone is always a surgical candidate either....

Even if it was CAD, pts can have CTOs, and we still try to fix what we can via the CCL instead of jumping straight to cabg.

We do a lot more then just toss stents in the coronary arteries.