Question re: Heparin drip vs. SQ

[TangoLima]

A few weeks ago I had a pt. who had initially been admitted to hospital due to spiral femur fracture, had a number of complications, been in ICU, and was then stepped down to our unit. He was on a heparin drip, which I just assumed was because he was immobile due to his fracture and needed anticoagulation.

So, the next morning I report to the nurse that the pt is on heparin, the drip rate, no s/s of bleeding, etc. And the nurse asks me WHY he is on a heparin drip. I must have looked like a deer in the headlights and just said that it was because of his immobility due to his fracture. Well, she looked at me like I was dumb, and said that I should know WHY a pt. is on heparin drip. So, the nurse then asks my preceptor the same question, and the preceptor gave her the same reply as I did. Anyway, the nurse stormed off to look in the chart, and apparently didn't find her answer there.

I have let it go since then, but still wonder WHY a pt. would be given a heparin drip rather than heparin SQ? I can't remember exactly, but the pt. may have had a PE at one point, so that may have been the reason. Any other reasons? Also, why use heparin vs. Lovenox? The only reason I have heard of is due to renal function.

[UM Review RN, ASN, RN]

A PE is a pretty good reason for a heparin drip. Some docs prefer heparin over Lovenox because they can get faster decrease in the systemic medication levels with heparin, if it's needed to take the patient off for some reason.

[bscn_rn_10_years]

I would assume without any kind of research on this pt, that there must have been multiple PE's for a hep drip to be used. I have worked with hep drips over the years but mostly for cardiac patients.

As for that nurse that stormed off, she should have handled the situation better and more professional. Instead of trying to make you feel stupid she should have educated you and took you over to the charts and the two of you could have researched together and if no answers there then you could have called the former unit and talked to them. ....well I guess it is easy for me to say ......but that is what I would have done.

[PiPhi2004]

I always get people like this with questions that I can't answer or answers that arent good enough. I give them the answer I have been given and the answer that seems to be spelled out in charting and that is never good enough. The same people do this crap over and over again. As others have said, PE is a good reason, but some docs/surgeons do wierd things and this could be one of those things. I usually just respond "Well that is what I have been told, I have read the chart extensively (Or I have been busy as crap and havent gotten the chance to read it) and if you find an answer better than this one please let me know for next time, I'd really appreciate it." This usually ends the conversation but its still irritating. Just know that its normal not to know the answer to every question you are asked and it doesnt make you a terrible nurse. Just get used to saying "I dont know, but I will find out!"

[love-d-OR]

As some of the other posters have stated, heparin drip will usually be seen in patients who have a hx of embolus (usually many). Post-op patients (not all) may also be on a heparin drip to prevent anastomosies occlusion and emboli formation. I actually have never seen a patient on heparin drip only because they were immobile, but that does not sound unreasonable.

I am yet to encounter nurses that have tried to belittle me with their questions and behavior during report, but I have heard and seen others being treated this way. Try to hold your cool and son't take it personally.