Preoperative Heparin Adminstration Timing

[ORnurse866, MSN, RN]

Hello fellow OR nurses,

I am curious what kind of protocol other organizations follow in terms of preoperative heparin administration for VTE prophylaxis.

Do you guys give pre op heparin (unfractionated, 5000 units, SQ) in the OR? Or in the preoperative holding area (e.g. Same Day Unit)? If it is given in the preoperative holding area, when is the timing to administer heparin?

I would appreciate if you add the size of the organization that you work at (e.g. the number of OR suites).

In my organization, which is Level 1 trauma center and has 40 operating room suites, we administer preoperative unfractionated heparin 5000 units SQ in the operating room when a patient gets to the room.

Thank you in advance!

[FurBabyMom, MSN, RN]

As an OR nurse in a Level 1 trauma center (> 30 rooms) - our facility primarily gave SQ heparin in pre-op or on the floor for those coming from ICU, stepdown or floor bed assignments (timed for ~1-2 hours before scheduled OR time).  Naturally, sometimes it got missed - or - before our EHR's day of surgery signed/held order bundles were updated - providers forgot it. So we certainly have given SQ heparin in the OR - I gave it myself plenty of times.

Think about the mechanism of action, how long a SQ med takes to be absorbed and why we give heparin. You want DVT prophylaxis (pharmacological or mechanical) to be effective before anesthesia is induced.  The changes that can lead to periop DVT formation can occur at the time of or after anesthesia induction.  At the most basic level, this concern and timing has to do with vasodilation (aka why almost everyone's BP drops secondary to an induction/intubation dose of propofol) not to mention being chemically restrained and sedated, etc.