New grad questions

[cjmon777]

Hello. Just to add a little bit of background, i'm a semi- new grad. I finished school last year and started as a fresh nurse in medical ICU around spring 2016. I hope in this thread people can post questions as new nurses in order to find guidance and confidence while balancing nursing and life outside of nursing. I already finished my 6 month orientation and my home unit preceptor was so helpful, but I couldn't bombard her with so many questions I still have lingering. I sometimes feel too shy to ask too many questions because even the most patient people will eventually get tired of giving too much. So. I'll start off with a question of mine.

I've been reading up on heparin drip protocols.. this might sound like a stupid question but do you need PTT results to start a heparin drip in order to have a baseline? or can you start one without PTT results as long as there's a set starting rate ordered by MD?

[canoehead, BSN, RN]

We draw a PT PTT before starting the drip, but we don't wait for the results. The doc orders the starting rate, and we titrate to effect.

[cjmon777]

Ah thank you so much. That helps a lot.

[la_chica_suerte85, BSN, RN]

I'm also a new grad but where I work, if we have questions like this, we refer to our P&P. A protocol like this would be facility-specific and depend on the reason for initiating heparin. A cursory literature search shows that, in an emergency setting, doctors rarely rely on a baseline PTT when initiating therapy (Are baseline prothrombin time/partial thromboplastin time values necessary before instituting anticoagulation? - PubMed - NCBI).

Here is a protocol for a hospital in my state: http://www.vchca.org/docs/hospitals/heparin-protocol-vault-(1).pdf?sfvrsn=0

Basically, this facility will not hold heparin if there are no baseline labs, but, ideally, baseline labs should be drawn. If there is a suspicion that the patient might be prone to bleeding, then, definitely, a PT and PTT should be drawn.

Merck Manual also has a weight-based heparin dosing that is adjusted 6 hours after the heparin is started and based on that time's PT/PTT: Pulmonary Embolism (PE) - Pulmonary Disorders - Merck Manuals Professional Edition

I hope that helps somewhat.

[cjmon777]

yessss it does help a lot. thank you so much. I've a lot to learn.