Heparin in an emergency-to draw PTT or not?

  1. In a semi emergency situation and a surgeon asks you to give 5000u IVP and then hang 1000u/hr of Heparin, but did not order to to get a PTT, do you normally get one anyone? He did not order a heparin protocol? I am new to med surg and I hear several seasoned nurses saying different things. I am not sure. I think next time I will ask the dr. if he wants a PTT. However, it seemed to be an emergency situation.
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    About Shell5

    Joined: Dec '04; Posts: 199; Likes: 40
    RN; from US
    Specialty: 13 year(s) of experience in Med Surg/Tele/Ortho/Psych


  3. by   Shell5
    I wanted to add that a 6 hr. post was ordered, but I am referring to the pre Ptt
  4. by   jnette
    Dang... I'd sure want one, (a pre) ..wouldn't you? Perhaps an oversight on his/her part? Do you have a standing order for these perhaps in your unit P&P manual? Might be a good idea to get something written on situations such as these.


    then again if it's an "emergency".... dunno. Can't wait to hear what the others would say.
  5. by   gitterbug
    draw it. most docs will sign the verbal. good base line.
  6. by   nursenatalie
    Our surgeons wouldnt give a rip what the ptt started out they would only want to change rate based on 6 hour ptt. Too late to get a baseline if you've already pushed the bolus. Some docs would be ticked that you took the time to draw a lab for baseline that wasnt ordered when the clinical picture must obviously show this pt is not anti-coagulated enough or else it wouldn't be an emergency to get the heparin going.
    Last edit by nursenatalie on Sep 9, '06
  7. by   mcdonaldgirl
    There should be a Protocol for a PTT to be drwn before any Heparin. What about people who are on long term ASA therapy?

  8. by   nursenatalie
    Please, aspirin is an anti-platelet drug and doesnt significantly increase ptt. Like I said, if the patient is having clinical symptoms that require heparin then best to begin heparin and adjust dose for efficacy. Worrying about a baseline ptt on a pt. who has not been on heparin therapy in an emergency situation instead of beginning treatment would infuriate some.
    Last edit by nursenatalie on Sep 9, '06
  9. by   jmgrn65
    a baseline ptt is useless, ASA doesn't effect ptt, nor another anti paltelet, such as plavix. It would only be good if the patient had been on heparin prior.
  10. by   TachyBrady
    I would check a Pt, Ptt, and a CBC before hanging the heparin just to cover my butt. Don't quote me but I do believe liver disease can elevate coagulation studies. There may be other conditions also but I would have to do some research to confirm this. A CBC is also a good idea in case they have a low blood count, i.e. existing bleed. How long does it take lab to come and draw blood? Where I work, it is maybe 10-15 minutes. You could be getting your bolus and infusion ready while waiting. If the patient were to bleed out, you could possibly be held responsible by not confirming these labs before giving the heparin. It would be helpful to know what your 'semi emergent' situation was. Sometimes you need to use your own judgement to weigh the risks. When I am in a situation where I absolutely don't know what to do, I call the doctor, emergency or not. Don't guess and don't assume.

    Just my 2 cents.
  11. by   ZASHAGALKA
    Without a baseline, you cannot effectively evaluate efficacy. High? compared to what? Is the heparin causing that high reading, or did they have an underlying problem? Will decreasing heparin adjust a subsequent level? Or, is it being driven by other factors that were failed to be addressed because a baseline wasn't drawn?

    If you give heparin to someone with a purposely uninvestigated anti-coagulopathy, you are liable for negligence. You don't need to hold it for the results, but you NEED a baseline result to evaluate the therapy. . . And, to abruptly change course and treatments if an anti-coagulopathy exists.

    If it's THAT much of an emergency, a stat lovenox dose can bridge the gap without destroying a baseline reading.

    I really don't place much stock in doctors being annoyed because I point out a standard of care to them. If I don't draw a baseline, there will WITHOUT A DOUBT be a charting entry that it was because a doctor pointedly refused it.

  12. by   gitterbug
    thanks, Zash, agree, a baseline is needed and does not take long to draw.
  13. by   Shell5
    :wink2: Thanks everyone.
  14. by   NurseyBaby'05
    Yes! Yes! YES! Get that PTT drawn STAT. What if the doc made a mistake and you give the bolus and cause the patient to bleed out? You gave the med. Also, be sure your protocol is followed. You can have a stat lab back in a very short time. If the doctor gets mad, tough! There was an incident within the health system where I work where this exact scenario occured and the patient wound up going to Neuro ICU bleeding out into his brain. He eventually died. The nurse and doctor are both fired and now their licenses are on the line; if not already suspended or revoked.
    Last edit by NurseyBaby'05 on Sep 28, '06