Does anyone have any guidance for the residents as to when to hold LMWH when awaiting emergency surgery?

We have had an incident here - iliofemoral DVT post appendectomy - didn't get an TP., and we are hoping to write some guidance for the residents re this - so many HAT when the LMWH is held

• Is the decision to 'hold' made by the medic or the nurse?
• Is rationale for the decision documented ?
• What advice re low Hb is given to medics  ie what  to consider when to decide to hold - eg bleeding?? - low ferratin.

Thanks guys

Ah Sue - trying to tame the untameable beast.

Decision to hold is sometimes made by the medic, sometimes by the nurse. Sometimes a reason is documented, sometimes not. In our opinion omission is only indicated pre biopsy/ ERCP/ surgery if it is imminent, as in within the next 6 hours (unless poor renal function). Like you, and no doubt many others, there is indecision around surgery, doses omitted the evening before, surgery postponed until the following day...... and repeat.

We are moving our default giving time for once-daily prophylactic LMWH to 2pm; I hope this will support appropriate administration pre-op, though will no doubt cause problems in other areas?

thanks Becs - usful information

We are trying to move away from set time for the TP as many patients are not getting it in the 14 hours that NICE recommend - come in at 19:00 - won't then get till 1800 the next day!!

so trying to get it given at the next drug round

So - for you - only omit if you know that surgery is imminent?

 

Yes; omit if surgery is on the same day. That is the plan....