Baseline ptt and heparin drip

[Ruth06]

I had a doctor that wanted a or started on a heparin drip immediately and my lady was a hard stick. My question is can I have lab backorder/run a Ptt and pt/inr off a previous CBC (done 2 hrs prior) that was drawn that morning to use as a baseline? I'm not sure what is involved in running the different labs. Just wondering if that was possible. It would have saved me a lot of time and trouble.

[dah doh, BSN, RN]

Yes you can have baseline ptt done off a previous specimen from the morning. However, the cbc is drawn in a purple top and ptt is a blue top so lab probably couldn't do it without a previous blue top. Did the doctor order a baseline ptt prior to starting the heparin gtt?

[Ruth06]

She didn't state that she wanted a baseline but it's our protocol to get one.

[oncivrn]

They are different tubes. Blue tops have a reagent in them. Generally cannot run a ptt off a sample >2 hours old anyway, at least at my institution.

Can you have a phlebotomist come in that situation? Heparin gtts suck. Glad they are not used as much anymore.

[Ruth06]

We do have phlebotomists but we are a very small hospital and sometimes even a stat lab order won't get drawn right away( it took them 20 min to come draw it). It took an hour from the time it was drawn to get the results, in which time I called them twice to see why it was taking so long bc the doctor was telling me to go ahead and start it bc the circulation was so poor in her foot. I went ahead and gave the initial bonus per the doctors orders and then told her I didn't feel comfortable starting the drip w/o the baseline Ptt. I documented well but I hated going against protocol. Thankfully we ended up shipping the pt quickly after the bolus bc we just don't have the specialists that this pt was going to need.

[oncivrn]

Even a stat ptt takes some time. I think you did everything fine. Honestly imo you could start heparin without the results as long as the sample had been collected.