Question to all surgical nurses?

Esme12, ASN, BSN, RN · Jan 17, 2014

thread moved for best response

krisiepoo · Jan 17, 2014

I'm not a surgical nurse but I recently, in clinicals, had someone who had just come back from an angiogram and had scheduled SQ heparin. We (my assigned nurse and I both wanted to make sure) talked to the charge nurse about this who said it was OK because it's a prophalytic dose

Gampopa · Jan 17, 2014

I would anticipate the Pt getting Protmine (heparine antidote) at the start of surgery provided the OR knew there was heparin on board.

SL2014 · Jan 17, 2014

We do this on our floor much of the time depending on the patient's coagulation status and the surgeon's orders. Sometimes they want you to give it, sometimes they don't. I almost always call to clarify if it isn't specified.

The big NO is Lovenox. It has a long half life and it is harder to reverse (if the MD chooses to try to reverse it at all).

nurseprnRN, BSN, RN · Jan 17, 2014

That's "pro-phy-lac-tic" and "prot-a-mine." Look up the difference between someone on anticoagulation therapy for new atrial fib (what's a common dose of heparin? how is it given? what lab test is used to check for optimal anticoagulation?) and prophylaxis for DVT postop (common dose, labs (if any), route of administration). And look up the meaning of "prophylactic" and "prophylaxis," too. It will help you understand.

Fully heparinized blood is what goes through the artificial kidneys used in hemodialysis. How do you suppose that is managed? Right. The heparin gets reversed with protamine.

Editorial Team / Admin · Jan 17, 2014

If the patient needed emergent surgery, what was the alternative? Not do the surgery, and allow the patient to die? It may not be optimal (depends on the dose- if you're talking about 5000 units heparin, that's not really going to drastically affect a patient without coagulopathies), but heparin can be reversed and blood products to promote clotting given. It's all about risks vs. benefits.

As for anticoagulation in elective surgeries, stopping the anticoagulation can be detrimental to the patients health. However, the surgeon may look at alternative medications that will provide the same effect. For example, I work in cardiac surgery. We have a large percentage of patients with chronic atrial fibrillation. What can happen in atrial fibrillation if the patient is not anticoagulated? Clots can form in the atrium, and travel to other areas. These patients can end up with strokes or pulmonary embolisms, both of which can be devastating or fatal. Warfarin (Coumadin) is often prescribed for these patients. However, when they are scheduled for surgery, the surgeons I work with will almost always have the patient stop taking warfarin one week to ten days prior and "bridge" with Lovenox instead. Patient is still anticoagulated, should not form clots within the heart, and can successfully have surgery.