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Discussion

Question about heparin

Hello everyone! Just a quick question about heparin... I came from a hem/onc unit and we NEVER used heparin...

I had a student, in clinical last week, who was assigned to care for a patient admitted with sepsis. The patient also had liver issues and had a platelet count of 80k. The patient was ordered sub-q heparin, which I felt was inappropriate due to the platelet count, so I had the student hold it and update her nurse. The nurse stormed down the hall, suggested that I don't understand DVT prevention, and told me that I shouldn't be teaching if I didn't have critical thinking skills. Now call me prudent and by-the-book, but I do not give heparin, or teach to do so, unless the platelet count is over 100k.

What I would like to know, from nurses in other specialty areas... Are you as conservative with heparin?

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    The way I see it is even if someone has thrombocytopenia they are still at risk for VTE and based off of this patient's sepsis and liver dysfunction it seems like they would be a high risk. I would run it by the ordering provider just to be sure. I routinely look at platelet counts, but I know there are some instances where the team still wants SC heparin as prophylaxis if the patient has a low count as long as they don't think that it's directly HIT related. Am I making sense? I don't think I'm making sense. It's a complex issue.

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    I work on an oncology unit, but have a large amount of general med-surg patients. I have given heparin before for counts even lower than 80k because they are very high risk for clots. It would completely depend on the patient. I don't think there would be a cut off number, just like if I hold a BP pill or not, the number depends on the patient and their medical history (unless there are parameters). If there was a critical I obviously wouldn't, and if the number was low enough to concern me, I would call the physician.

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    Used to be an onco nurse and I've seen several patients with plt counts

    Given the hypercoaguable state that exists with cancer, it's appropriate to give it.

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    I would still give it, but I don't think you are wrong to be questioning. I have had liver pts with bleeding issues ordered Heparin that the docs later realized was a mistake. I think a lot of med-surg nurses don't really think about risks before giving Heparin subq so it is good that you are

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    I don't know the exact count but it has to be pretty low to hold on my floor. I work post-op. Usually the only time we don't give it is prior to surgery.

    You are making your students think about labs prior to giving meds which is important, she should have educated you instead of flipping out. If it is not something you do every day you are not going to be an expert.

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    Thanks for your input! I worked 8 years on a BMT hem/onc unit and as I said... we NEVER gave heparin to anyone. Just always like to know what my other colleagues do!

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