Vitamin K used incorrectly.....INR 1.8

[GoNightingale, BSN, RN]

I am very concerned about an order I received today from a cardiologist (surgeon) that would be taking my patient to cath lab today. The patient's INR in this am's lab results was 1.8. The order read if patient INR is

I always thought that vitamin k is an antidote for over anticoagulation. I'm afraid something happened and i will get in trouble. I don't know because I did not work today.

does anyone have any idea why this doctor would place suck an order?

Thanks.:redbeathe

[Rose_Queen, BSN, MSN, RN]

An INR >1.5 is one of the primary reasons surgeries get cancelled where I work. Considering the type of surgery and potential for blood loss, a high INR could lead to an adverse outcome because the patient will not be able to clot. Considering that cath labs frequently access the femoral artery, you really don't want the patient at a high risk of bleeding. I've seen some cath lab patients come screaming into the OR in need of multiple units of blood and a good vascular surgeon because they won't stop bleeding or the access site doesn't clot off. My guess would be that if the INR was over 2, you would have been given an order for platelets.

[GoNightingale, BSN, RN]

Thanks for your reply. I'm a 2 year old nurse on a Tele unit. Can you clarify this for me. I was under the impression tha an INR between 2-3 is normal. Anything above this is a risk for excessive bleeding. Anything below this is a risk for excessive clot formation. Isn't a normal range a good situation to go into the cath lab with?

[Rose_Queen, BSN, MSN, RN]

Actually, an INR between 2-3 would be therapeutic for someone needing anticoagulation. Normal INR for someone not on anticoagulation therapy would be 1-1.2 (your hospital's normals may vary slightly, these are what they are where I am).

[Penelope_Pitstop, BSN, RN]

My guess would be that if the INR was over 2, you would have been given an order for platelets.

We usually do FFP.

[Rose_Queen, BSN, MSN, RN]

We usually do FFP.

Oops, we do too. Just had platelets on the brain thanks to a heart case.

[GoNightingale, BSN, RN]

:yeah:Thanks very much for your reply. That really clarified this physician's orders for me. I love nursing! I learn something new every day!

To all the male nurses out there whi are fathers, Happy Father's day!:redbeathe

[SillyInScrubs]

The order read if patient INR is

Sorry I just read this and I'm a little confused... Wouldn't you give the vit. K if the INR were higher than 2, not less than?

[creo]

I would also check with the Pharmacist. They can also give you advice.

[agent]

I would also check with the Pharmacist. They can also give you advice.

good tip, pharm can be your friend when you need help questioning a physician order.. this order for vitK sounds pretty normal for me though

[kayern]

First, what anticoagulation meds was the patient taking? How was the liver profile? For instance, the dose of coumadin you take today really affects the INR two days later. There's more to anticoagulation therapy other than INR. Consider this, if the cath is normal, the patient will be difficult to anticoagulate again with all that Vit K on board. Maybe platelets should have been consider.

[kayern]

Sorry not platelets but FFP