Podcasts about Heparin

Welcome back to the tasty morsels of critical care podcast. Following on from the recent post on Heparin, today we're going to talk about one of its more significant complications – Heparin Induced Thromboyctopaenia or HIT for short. In my ... Read More »

Contributor: Travis Barlock, MD Educational Pearls: What is Portal Vein Thrombosis? The formation of a blood clot within the portal vein, which carries blood from the gastrointestinal tract, pancreas, and spleen to the liver Not only can this cause problems downstream in the liver, but the backup of venous blood can cause ischemia in the bowels How does it present? Similar to acute mesenteric ischemia: Sudden onset of abdominal pain, nausea, vomiting, and fever How is it diagnosed? Abdominal CT or MRI with contrast What causes it? Cirrhosis Coagulopathy (Factor V Leiden mutation, Prothrombin gene mutation, Antiphospholipid syndrome, Protein C, protein S, antithrombin III deficiency, etc.) Oral Contraceptive Pills (OCPs) Cancer such as hepatocellular carcinoma How is it treated? Aggressive fluid resuscitation Antibiotics. Be sure to cover enteric gram-negative bacteria and anaerobes Heparin, same dosing as a bolus for a DVT Endovascular treatment, such as a thrombectomy with IR Surgical evaluation if there has been tissue death in the mesentery References Hilscher, M. B., Wysokinski, W. E., Andrews, J. C., Simonetto, D. A., Law, R. J., & Kamath, P. S. (2024). Portal Vein Thrombosis in the Setting of Cirrhosis: Evaluation and Management Strategies. Gastroenterology, 167(4), 664–672. https://doi.org/10.1053/j.gastro.2024.05.017 Intagliata, N. M., Caldwell, S. H., & Tripodi, A. (2019). Diagnosis, Development, and Treatment of Portal Vein Thrombosis in Patients With and Without Cirrhosis. Gastroenterology, 156(6), 1582–1599.e1. https://doi.org/10.1053/j.gastro.2019.01.265 Ju, C., Li, X., Gadani, S., Kapoor, B., & Partovi, S. (2022). Portal Vein Thrombosis: Diagnosis and Endovascular Management. Pfortaderthrombose: Diagnose und endovaskuläres Management. RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin, 194(2), 169–180. https://doi.org/10.1055/a-1642-0990 Summarized by Jeffrey Olson MS3 | Edited by Jorge Chalit, OMS3 Donate: https://emergencymedicalminute.org/donate/  

In this episode, we review the high-yield topic of⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Heparin-Induced Thrombocytopenia (HIT)⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠from the Hematology section. Follow ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets

A southwestern Manitoba farmer is calling on government and industry to explore the feasibility of establishing a processing facility that would extract medical compounds from the byproducts of hog processing.Heparin is a blood thinner that prevents the formation of blood clots.Jim Downey says he became interested in the medical side of production about three years ago when he was contacted by a Chinese company looking to find out what was being done with the mucosa from the guts of the hogs being slaughtered in Manitoba.The July heat did a number on 2024 crop yields in Saskatchewan, but it did prevent major disease outbreaks.Sandy Junek, the Molecular Lab Manager with Discovery Seed Labs in Saskatoon says seed germination levels range from good to very good.See omnystudio.com/listener for privacy information.

Show notes at pharmacyjoe.com/episode983. In this episode, I'll discuss four potential reasons for a false heparin anti-Xa level. The post 983: Four Potential Reasons for a False Heparin Anti-Xa Level appeared first on Pharmacy Joe.

Guest: Cheryl Maier MD, PhD Heparin resistance occurs when patients don't respond to anticoagulation as expected, even with what seems like the appropriate dose. Join Dr. Cheryl Maier, who spoke about this topic at the 2024 American Society of Hematology Annual Meeting, to learn more about testing methods, the role of antithrombin, and alternative treatments, like direct thrombin inhibitors. Dr. Maier is an Assistant Professor in the Department of Pathology and Laboratory Medicine at Emory University and the Medical Director of the Emory Special Coagulation Laboratory in Atlanta, Georgia.

In this episode, Dr. Valentin Fuster discusses a pivotal study comparing bivalirudin and heparin anticoagulation in STEMI patients undergoing primary PCI, highlighting that bivalirudin may reduce cardiac mortality and bleeding without increasing thrombotic events. While the findings challenge previous guidelines favoring heparin, limitations in the research prompt caution about immediate changes to clinical practice, emphasizing the need for further exploration of bivalirudin's role in diverse patient populations.

It's been a long time, but we are back!Apologies on the audio quality from Dr. Jenkins. Apparently he was recording from inside a cardboard box.Today we talk about important, practice changing studies in internal medicine from the last several months. What's the best anticoagulant in patients with cirrhosis and atrial fibrillation? Why do doctors use so much unfractionated heparin for acute PE? Should we still be using beta blockers in patients with acute MI? Does finerenone improve outcomes in HFpEF? Is continuous infusion of antibiotics better than intermittent? And will the cefepime vs piperacillin-tazobactam battle ever end?Apixaban, Rivaroxaban and Warfarin in Cirrhosis for AFAnticoagulation Trends for Acute PEBeta Blockers for Acute MI with Normal EF Finerenone for HFpEF FINEARTS-HFContinuous vs Intermittent Infusion of Beta-Lactams BLING IIIProlonged vs Intermittent Infusions of Beta-Lactams Meta-analysisPiperacillin-Tazobactam vs Cefepime for SepsisRecurrent SBP in Patients on Secondary Prophylaxis

In this episode, we review the high-yield topic of ⁠⁠⁠⁠Heparin-Induced Thrombocytopenia (HIT)⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠from the Heme section. Follow ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets Linkedin: https://www.linkedin.com/company/medbullets

An exciting new academic year is about to begin. We know this can be daunting, especially for our newest hematology/oncology fellows. Over the next two weeks, we re-boot some of our high yield episodes you need to know to prepare for your first days as a new fellow and your nights on call. Next up: Heparin-induced thrombocytopenia! [Originally episode 071]Contents: - What is HIT? How is this different than HITT?- How do we make this diagnosis? - How do we treat HIT/HITT? ** Be sure to check out our rotation guide for more show notes and episodes organized by disease type: https://www.thefellowoncall.com/rotation-guides** Want to review the show notes for this episode and others? Check out our website: https://www.thefellowoncall.com/our-episodesLove what you hear? Tell a friend and leave a review on our podcast streaming platforms!Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast

In this episode of the Real Life Pharmacology podcast, I cover drugs 16-20 of the top 200 drugs. This podcast includes information about clozapine, furosemide, heparin, tetracycline, and vardenafil. Clozapine has five boxed warnings and these are all items that you may see on your pharmacology and board exams! I've also blogged about these in the past at meded101. Furosemide is a loop diuretic and a common indicator of the prescribing cascade. I discuss this in this podcast episode. Heparin can cause thrombocytopenia. I discuss what HIT (heparin-induced thrombocytopenia) may look like.

Welcome to Abiomed's Quarterly Update, where education is at the forefront. In this episode, host Shane Turner is joined by Jena Billig, primary trainer for the West region, to dive into the intricacies of the Impella pump's heparin-free purge system.Jena provides a comprehensive understanding while addressing misconceptions. She explains the importance of using a dextrose and water-based purge solution with heparin or sodium bicarb additive to prevent blood proteins from accumulating in the pump motor housing. Plus, Shane and Jena explore new features of the Impella Five, gen two catheter, designed to enhance safety for transport providers, including the intuitive catalog system and three-point fixation method.Whether you're a seasoned provider or new to the field, this episode offers valuable insights to improve patient care and transport practices. Tune in now to stay informed and elevate your knowledge of the Impella device and purge system!In this episode:Shane Turner, RN, CFRN, NRP, FP-C, CMTE, Chattanooga, TNJena Billig, BSN, RN, CCRN, CFRN, Idaho Springs, Colorado

Background: The mainstay of treatment for symptomatic pulmonary embolism  (PE) is anticoagulation (AC).  Patients with higher-risk PE may require advanced interventions such as thrombolytic therapy, surgical thrombectomy, or even extracorporeal membrane oxygenation (ECMO). Because of its short half-life and availability of a reversal agent, unfractionated heparin (UFH) is commonly used when percutaneous or surgical interventions ... Read more The post REBEL Cast Ep125: 1st 48 Hours of PE Management – How Good Is Unfractionated Heparin? appeared first on REBEL EM - Emergency Medicine Blog.

N Engl J Med 2008; 358:2218-2230Background The use of percutaneous coronary intervention (PCI) is associated with improved outcomes in patients with ST-segment elevation myocardial infarction (STEMI). Nonetheless, there was a need to further improve survival rates. As seen in OASIS-6, the 30-day mortality in the control arm was still high at 8.9%. Glycoprotein IIb/IIIa inhibitors emerged as a potential solution. US clinicians widely adopted these agents; their use soared to over 90% of STEMI cases undergoing primary PCI. But IIb/IIIa inhibitors increase the risk of bleeding and thrombocytopenia.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.Bivalirudin, a direct thrombin inhibitor, has been shown to reduce bleeding when used instead of heparin plus glycoprotein IIb/IIIa inhibitors in patients with ACS without ST segment elevation. The Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial sought to test the hypothesis that bivalirudin is superior to the combination of heparin plus glycoprotein IIb/IIIa inhibitors in patients with STEMI who were undergoing primary PCI.Patients Patients were enrolled if they were within 12 hours from the onset of symptoms and had ST-segment elevation of 1 mm or more in two or more contiguous leads, new left bundle-branch block or had posterior myocardial infarction. There were numerous exclusion criteria including bleeding diathesis, coagulopathy, intracerebral mass, prior hemorrhagic stroke, platelet count< 100,000 cells/ ml, hemoglobin< 10 g/dl plus many more.Baseline characteristics The trial enrolled 3,602 patients. The average age of patients was 60 years and 77% were men. About 53% had hypertension, 43% had hyperlipidemia, 16% had diabetes, 11% had prior myocardial infarction and 46% were current smokers. The majority of patients were stable, with 91.5% classified as Killip class I. Primary PCI was performed in about 93% of the patients and coronary artery bypass graft surgery in 1.7%.Heparin before coronary angiography was administrated in 76.3% in the heparin plus glycoprotein IIb/IIIa inhibitor arm and 65.8% in the bivalirudin arm. During coronary angiography heparin was administered in 98.9% patients in the heparin plus a glycoprotein IIb/IIIa inhibitor arm and 2.6% in the bivalirudin arm. Glycoprotein IIb/IIIa inhibitors were given to 94.5% patient in the heparin plus glycoprotein IIb/IIIa inhibitors arm and 7.2% in the bivalirudin arm.Procedures The trial was open-label and patients were randomly assigned 1:1 to receive unfractionated heparin plus a glycoprotein IIb/IIIa inhibitor or bivalirudin alone. Heparin was administered to keep activated clotting time of 200 to 250 seconds. An initial intravenous bolus of 60 IU/ kg was given followed by boluses as needed. Bivalirudin was administered intravenously with an initial bolus of 0.75 mg/kg followed by an infusion of 1.75 mg/kg/hour. A glycoprotein IIb/IIIa inhibitor was administered before PCI in all the patients in the heparin group. It was also administered in selected patients in the bivalirudin group if there was no reflow or there was a large thrombus after PCI. The main glycoprotein IIb/IIIa inhibitors used were abciximab or eptifibatide.Endpoints The study had two primary endpoints at 30-days. The first endpoint was major bleeding not related to coronary artery bypass graft surgery. The second endpoint was a composite endpoint of major bleeding, all-cause death, reinfarction, target-vessel revascularization for ischemia or stroke.Analysis was performed based on the intention-to-treat principle. Assuming a 30-day event rate of 9% for the first endpoint and 12% for the second endpoint in the heparin plus glycoprotein IIb/IIIa inhibitor group and 6% for the first endpoint and 9% for the second endpoint in the bivalirudin group, a sample size of 1,700 patients in each group would have 99% power to show superiority of bivalirudin for the first endpoint and 80% power for the second endpoint.Results The study randomized 1,802 patients to the heparin plus glycoprotein IIb/IIIa inhibitor group and 1,800 patients to the bivalirudin group.The first primary endpoint was significantly lower with bivalirudin (4.9% vs 8.3%, RR: 0.60, 95% CI: 0.46 - 0.77; p

Commentary by Dr. Candice Silversides

Jody summarizes what he learned recently at the HH Cardiology Update 2024, held at UA Huntsville College of Nursing. Resources: UAH Kinesiology CPET Nunn AVW, Guy GW, Brysch W, Bell JD. Understanding Long COVID; Mitochondrial Health and Adaptation-Old Pathways, New Problems. Biomedicines. 2022 Dec 2;10(12):3113. doi: 10.3390/biomedicines10123113. PMID: 36551869; PMCID: PMC9775339 2022 ACC/AHA Aortic Disease Guidelines StatPearls Water Hammer Pulse Article Water Hammer Toy Demo (YouTube) StatPearls COX Inhibitor Article AHA Anticoagulation Strategies for PCI Bivalirudin vs Heparin in STEMI Glycoprotein IIA/IIIB Inhibitors P2Y12 Inhibitors McLaughlin K, Rimsans J, Sylvester KW, Fanikos J, Dorfman DM, Senna P, Connors JM, Goldhaber SZ. Evaluation of Antifactor-Xa Heparin Assay and Activated Partial Thromboplastin Time Values in Patients on Therapeutic Continuous Infusion Unfractionated Heparin Therapy. Clin Appl Thromb Hemost. 2019 Jan Dec;25:10760296 19876030. doi: 10.1177/1076029619876030. PMID: 31530176; PMCID: PMC6829967. Cirillo P, Taglialatela V, Pellegrino G, Morello A, Conte S, Di Serafino L, Cimmino G. Effects of colchicine on platelet aggregation in patients on dual antiplatelet therapy with aspirin and clopidogrel. J Thromb Thrombolysis. 2020 Aug;50(2):468-472. doi: 10.1007/s11239-020-02121-8. PMID: 32335777; PMCID: PMC7183388. ESC Cardio-oncology Guidelines 2022 ESC Guidelines Key Points (ACC) ICOS Cardio-oncology Risk Assessment Tool Ibrutinib Associated Cardiotoxicity SPARC Tool ATRIUM Clinical Trial Information ACC Cardiosmart UAB ICOS UAB Cardio-oncology Program

Today we want to unravel the intricate relationship between anticoagulants and regional anesthesia. Join Garry and Terry as they navigate through the delicate balance of benefits and risks associated with these practices. We'll dive into the world of anticoagulation reversal agents, discussing FDA-approved options such as Idarucizumab and Andexanet. So join Garry and Terry as they navigate the complexities of anticoagulants and regional anesthesia, emphasizing the critical role guidelines play in ensuring patient safety in the ever-evolving landscape of anesthetic practices.   Here's some of what we discuss in this episode: The evolving perspectives on NSAIDs, COX-2 inhibitors, and aspirin, emphasizing recent data that challenges initial concerns about spinal hematomas. Neuraxial anesthesia, celebrated for positive outcomes, brings its own set of risks, notably bleeding and hematoma formation. Heparin administration, both subcutaneous and intraoperative, prompts nuanced considerations, ensuring safety in the neuraxial procedure. Insights into thrombolytic therapy, urging caution due to limited clinical data.   Visit us online and get show resources here: https://beyondthemaskpodcast.com/   Get the CE Certificate here: https://beyondthemaskpodcast.com/wp-content/uploads/2020/04/Beyond-the-Mask-CE-Cert-FILLABLE.pdf   Help us grow by leaving a review: https://podcasts.apple.com/us/podcast/beyond-the-mask-innovation-opportunities-for-crnas/id1440309246

In this episode Liz and Jesse are joined once again for a great part 2 by Professor Ian Coombes. Ian is the Director of Pharmacy at RBWH and an expert in safety thinking. Ian looks at the what and why of the most common error prone medication types. Ian's Five (Plus One) Things: Paracetamol and other analgesics, Insulin and other diabetic medicines. Heparin, enoxaparin and other anticoagulants. Antimicrobials. Cardiac medicines in the hospital setting. Cytotoxic drugs.

In this week's episode we delve into the world of cardiac catheterization and speak with Assistant Professor of Pediatrics at USC, Dr. Neil Patel about a recent work he co-authored at Children's LA about continuation of anti-coagulation during catheterization. Does AC have to be stopped to safely perform a catheterization? Are there certain cases or patients in whom the risk may be especially high? What about NOACs or DOACs? When should closure devices be considered? These are amongst the questions posed to Dr. Patel this week.DOI: 10.1007/s00246-023-03097-x

Show notes at pharmacyjoe.com/episode874. In this episode, I’ll discuss what Impella purge solution can be used if the patient has a contraindication to heparin. The post 874: How Well Does a Bicarb-Based Impella Purge Solution Work for Patients With Contraindications to Heparin? appeared first on Pharmacy Joe.

Show notes at pharmacyjoe.com/episode874. In this episode, I’ll discuss what Impella purge solution can be used if the patient has a contraindication to heparin. The post 874: How Well Does a Bicarb-Based Impella Purge Solution Work for Patients With Contraindications to Heparin? appeared first on Pharmacy Joe.

Dr. Hill, Scott, Ray and Caleb gather together to talk about some random peds, protocol, drug administration and airway notes from the previous episodes. Heparin administration is the opening chat then we move into airway evaluation, using protocols and helpful items like Broselow tapes.  We even through in some documentation for refusal tips!

This week's episode is a quick one, focusing on heparin induced thrombocytopenia (HIT). We will go over the the pathophysiology, diagnosis and treatment of HIT.

Normal 25 - 35 seconds Indications Detection of coagulation disorders Evaluate response to Heparin (PT for Coumadin) Preoperative assessment Description Partial Thromboplastin Time (PTT)evaluates the function of factors I, II, V, VIII, IX, X, XI, and XII. PTT represents the amount of time required for a fibrin clot to form. Monitors therapeutic ranges for people taking Heparin. What would cause increased levels? Disseminated Intravascular Coagulation (DIC) Clotting Factor Deficiencies: Hypofibrinogenemia Von Willebrand Disease Hemophilia Liver disease: Cirrhosis Vitamin K deficiency Polycythemia Dialysis What would cause decreased levels? N/A

We revisit a topic covered previously as part of our “Heme/Onc Emergencies” series: heparin-induced thrombocytopenia (HIT) in Episode 017. As part of our return, we dive deeper into the pathophysiology, principles of diagnosis, and management of HIT to help you to better understand how to approach the question of “is this HIT?” as a Hematology consultant and, more importantly, how to guide management based on your index of suspicion.Content: - What is the pathogenesis of HIT?- What are risk factors for HIT?- How do we diagnose HIT?- What are the assays that we use to make this diagnosis and how do the assays work? - Practical points about management of HIT/HITT** Want to review the show notes for this episode and others? Check out our website: https://www.thefellowoncall.com/our-episodesLove what you hear? Tell a friend and leave a review on our podcast streaming platforms!Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast

In this podcast, our Medical Director, Dr. Brad Lewis, discusses heparin-induced thrombocytopenia, also known as HIT. Dr. Lewis addresses what HIT is, how to diagnose and interpret testing, and the role of functional testing like the HIPA (Heparin-Induced Platelet Antibody) test.

Kelsey would title her VBAC story, “When Everything Goes Wrong”. This episode is a must-listen as she shares her VBAC birth after testing positive for Group B Strep.Kelsey's first provider: Pushed a scheduled C-section due to a possible big babyChose elective C-sections for all of her own birthsKelsey's second provider:Wasn't concerned about Kelsey's blood clotting disorderDidn't push for induction upon borderline amniotic fluid levels Limited cervical checksSuggested a Cook's Catheter at 0 centimeters dilated with ruptured membranesDidn't push for C-section after 24 hours of ruptured membranes with GBSWe are incredibly grateful for all of those VBAC-supportive providers out there! They make ALL the difference. Additional LinksThe VBAC Link Blog: Group B Strep Prevention and Your Options for GBS+ BirthHow to VBAC: The Ultimate Prep Course for ParentsThe VBAC Link Facebook CommunityFull Transcript under Episode DetailsMeagan: Hello, hello you guys. Welcome to The VBAC Link. This is Meagan, your host of The VBAC Link. We have a story for you today that has been something that we've been seeing trickling in our inbox a lot. So I went onto our VBAC Link Community on Facebook and said, “Hey, I'm looking for some stories with this specific topic.” That specific topic is GBS, so Group B Strep if you don't know what GBS means. That is something that we've been seeing in our inbox of people being told they cannot have a vaginal birth if they test positive for GBS which we all know, I hope through listening to these episodes that you'd know by now, is false. If you are told that you absolutely cannot have a TOLAC, a trial of labor after Cesarean because you have Group B Strep, that is not true. That is just simply not true. We have our friend Kelsey today from outside of Dallas, Texas is that right? Kelsey: Yes. Yes, yeah that's right. Meagan: Yes and she is going to share her story just proving that. Another fun twist to her story is that she had a rupture of membranes. One of the things providers fear more or worry most about is GBS and rupture of membranes and the longevity of the membranes being ruptured increasing risk of infection. So a lot of providers will say, “If you have GBS, the second your water breaks, TOLAC or not, you need to come in and start antibiotic treatment immediately.” There is definitely some evidence with treating with antibiotics and we're going to talk about some of that in the end and also some ways that you can try and avoid testing positive for GBS, but one of the crazy things or cool things I should say about Kelsey's story is that her rupture of membranes was 24+ hours. So a lot of the times, we have providers also saying after a certain amount of hours and they have a cutoff or a certain number of doses of antibiotics, we're at a high risk for the newborn getting GBS and then we need to have a Cesarean. So I'm excited to hear Kelsey talk about her journey with 24+ hours with a rupture of membranes with GBS. Then another twist to her story is when she did arrive, she was a certain centimeter that a lot of people also think can't be helped. I'm just going to leave that right there and we'll let Kelsey talk about that. Review of the WeekBut of course, we have a Review of the Week so I want to dive into that. This was back in 2021, so a couple of years ago actually from mckenna_123 and her subject is “You're Not Alone, Mama.” It says, “When I had my first baby 7 months ago via C-section due to placenta previa, I was left discouraged and sad with little to no tools to help me process all that had happened. It was hard for me to tell my story to others confidently and joyfully because I felt so isolated by the experience. Enter The VBAC Link.” Ooh, that just gave me chills actually.“I spent my early postpartum months listening to an episode every day while I nursed my newborn. When I came across the placenta previa story on the podcast, I felt so seen and understood. This podcast gave me the opportunity to feel bound to other strong mamas who have healed from similar experiences. All of a sudden, I didn't feel so alone. I'm not pregnant with baby #2 yet, but when that happens, I will be armed with invaluable tools and knowledge for my journey to have a beautiful and redemptive VBAC. Thank you ladies for being the voice for moms who feel alone and unseen.” Whoa. I got chills all while reading that whole thing. She is so right. You are not alone. We are here with you. I know I've said this before and I'm going to say it a million times again but here at The VBAC Link, we truly love. I know we don't know you, but we love you and we don't want you to feel alone. That is why we created The VBAC Link because we felt alone. We were in that spot. Julie and I years and years ago felt alone wanting to have this vaginal birth which seemed so normal. Vaginal birth just seems like it should be normal. That's what happens, right? But then we had these C-sections, unexpected and undesired and we didn't know where we belonged. We didn't know what we could do. We didn't know who was saying whether that was true or not. That is why we are here. That is why The VBAC LInk exists. So thank you, McKenna, so much. Congratulations on your baby that is now probably almost two. Kelsey: And we need an update, McKenna. Meagan: We need an update. Are we having another baby? Where are we at? Are you still with us? Let's hear that update. Definitely email us. If you haven't had the time or a chance to put a review in, we would love that. We love getting them in the email box, on Apple Podcasts, and on Instagram. We love seeing your reviews. I'm not kidding you. When I was reading this review, I would get chills and then they would go down and then I'd get chills again and then they'd go down. They mean so much. So definitely if you haven't, drop us a review. Kelsey's StoryMeagan: Okay, Kelsey. Welcome to the show. Kelsey: Hey, thanks for having me, for having me on the VBAC podcast. I'm so excited to be here. Meagan: Oh my gosh. Well, I am so excited that you are here and sharing, like I said, such a great topic because I don't know. Tell me what you have heard about GBS. Have you heard that you can't have a vaginal birth with GBS? Or have you heard anything like that?Kelsey: Oh absolutely. Not from my doctor per se and I'll give you some more info about that as I share my story, but I believed that everything had to go according to plan despite listening to y'all's episodes, despite hearing other VBAC stories, I just felt like there is no way that I can have this vaginal birth after a Cesarean unless everything goes just as it should. My story is one that should be titled, “When Everything Goes Wrong”. Meagan: Okay, “When Everything Goes Wrong”. Kelsey: Yes, yes. I definitely heard that. One of the things that I kept in mind and I'll mention this too is that when you have ruptured membranes longer than 24 hours– I mean, I Googled this last night just to be sure. You'll see all over the place, “You've got to get baby out. You've got to get baby out. You've got to get baby out,” and that just wasn't the case for me. So yeah, I've got a lot of fun to unpack with you. Meagan: Yeah, and actually, my water was broken for over 24 hours too and so I connect so much to that because I hear it so much with our clients, “Within 24 hours, if you haven't had a baby, we've got to get baby out.” Some people are like, “Oh, within 8-10 hours, if contractions haven't started, we have to induce.” But that's not necessarily the case and we are two people that are living proof of that. Kelsey: Absolutely. Absolutely. Can I start by giving you just a little rundown of baby #1?Meagan: Absolutely. I was going to say, let's unpack where it all began. That's exactly where it began, right? Kelsey: That's exactly where it began. My son was born via scheduled Cesarean in July of 2018 at 40+2. I had never felt a contraction prior to having my son. I was diagnosed with polyhydramnios in the latter weeks of that pregnancy which of course as you know, leads to increased ultrasounds, and the more ultrasounds you have, the more– I don't want to say that things can go wrong, but he did get the big baby label because he was seen so much. Of course, you guys have shared that those can be up to 2 pounds in either direction. I remember somewhere along the 36-38 week mark, my provider because discussing delivery with me and she mentioned that she would hate to see me run out of the clock on a 24-hour labor which should have been red flag #1. Meagan: Uh-huh. Kelsey: She said that I would be so tired from laboring all day only to have a newborn that would not let me get any rest. She mentioned shoulder dystocia and that he would get stuck. She pulled out all of the stops. Then she even said– and you're going to die when I tell you this– she said, “I've seen too many things go wrong with vaginal deliveries during my residency and it's why I chose elective Cesareans for the births of my own children.” Meagan: Oh, dear. Oh, dear. She is in the wrong field. Kelsey: I don't want to demonize her. I trust that she was–Meagan: Probably speaking from her heart. Kelsey: Yes. She was. She was not out to get me. Meagan: No, and this is the thing. A lot of the time, these providers have this bad rap. I'm like, “Oh dear, red flag.” They do take, a lot of the time, from what they have maybe seen. She was mentioning shoulder dystocia. Maybe she's seen really hard shoulder dystocia so she fears that. She fears that but she's labeling every other birth that way to the point where she even scheduled her own Cesarean because she was that scared of vaginal birth. Right?Kelsey: Right. Meagan: If you have a provider that is that scared of vaginal birth for herself, then that is a red flag for sure. Kelsey: Yeah, absolutely. Meagan: But we don't even think about that. Kelsey: Yeah, and I didn't have the knowledge or experience to present a case for vaginal delivery for myself nor did I feel like I had the ability to so I walked in and had a scheduled Cesarean. It was very routine, very rote. My son did weigh 9.5 pounds, but there I was a first-time mom. I felt like this experience that I so desired to have, this vaginal birth, was snatched right out from under me. I had never felt a single contraction. I don't know why that was so important to me, but I just felt like I was missing something. Meagan: It's a signal to our minds and our brains that our baby is coming. Kelsey: Yeah. Meagan: It's a sure sign when we start having contractions and experiencing labor that, “Okay. We are now entering this stage.” I swear because the same thing, I remember the last time I felt a contraction with my second and I was sad. I'm like, “Wait. Where did they go?”Kelsey: Yeah. So that feeling really set the stage for the birth of my daughter. She didn't come until about 4 years later, but I knew that the first weapon in my arsenal would be to find a new provider. I conducted some interviews with two providers here in the Dallas/Fort Worth area. You are a part of the Facebook pages like DFW VBAC and you see names pop up over and over again. I chose Dr. Downey who you guys actually, one of your very first episodes was with a gal named Rachel and she used Dr. Downey for her VBAC. I remember there were 13 months between her Cesarean and her first VBAC. Meagan: Wow. Kelsey: So we've got a repeat doctor on here. Meagan: Yeah, that is really good to know. Dr. Downey. Kelsey: Dr. Downey, yeah. He was amazing. He never batted an eye. He briefly mentioned induction by 41 weeks due to health concerns on my end. It was nothing major, but I had a few markers for antiphospholipid antibody syndrome. Meagan: I don't think I've ever heard of that. Kelsey: It's a blood clotting disorder. Meagan: Oh, okay. Kelsey: So I was on Heparin shots. Lovenox shots and then moved to Heparin shots closer to delivery. But he was largely very patient. Very, very patient. He said, “You're going to be getting a call from the hospital to schedule an induction by around 41 weeks.” I kept waiting, waiting, and waiting for the call. I hated the waiting. I wanted to decline the induction, but I also, to be honest with you, wanted to follow my doctor's advice so I felt like I was in a really weird place. Anyway, I never got that phone call. I never got that call to schedule an induction. I never had to make that decision because the hospital was packed and they didn't have room for me and it was not truly medically necessary so I left my 40-week appointment with my next appointment scheduled for 41 weeks and he was like, “Okay. I guess we're just going to wait for you to go into labor.” I said, “Great. I love that.” So fast forward to my due date, I texted my doula that afternoon an update, and at about 9:30 PM that evening, to my surprise, I started cramping sporadically but because I had never felt a contraction as I said, “I just kept thinking, is this it? This can't be it. This is it. It has to be. It can't be. What is going on?”I even got out my contraction timer just to see. My sense of time was so distorted because I was excited but confused. So I got out my contraction timer just to see how long were these cramps. How much time was between them? I didn't expect any regularity, but I did continue to cramp until early morning. I woke my husband up. Talk about excitement. That guy got showered, packed a bag, and was fully dressed in 7 minutes. Meagan: Oh my gosh. That's awesome. Kelsey: I very kindly reminded him that this could take a while. He should probably rest. I was resting as best as I could, eating, and drinking, and at 3:21 AM the next morning, I felt that little pop that everyone talks about that you just don't really know until you experience it. I was glad. Is there such a thing as TMI on this show? Meagan: No. No. Kelsey: I had a pad on by that point because I had some bloody show. I was so glad because I didn't have this massive gush of water. It was just some leaking. When I went to the restroom, I noticed that it was not clear. I think one of the things that I hope people glean from my story is that you have to do what you're comfortable with despite risk and statistics and all of the numbers. I knew that yes, I could stay at home and I could continue to labor but I just felt more comfortable going to the hospital with the fact that my waters were not clear. Meagan: Yeah. Kelsey: I called my doula. I send her pictures, God bless her, and with my own gut feeling, my husband's urging and her advice, we headed to the hospital about 2 hours later and we were admitted by 7:30 AM that next morning. Meagan: Yeah. I just want to talk about despite what evidence may say, “Oh yeah, I'm safe to be here but my heart says that I shouldn't.” That is so important to listen to. We talk about it on the podcast all of the time. What does your heart say? What does your gut say? But it really, really, really is so important. I love that you had a doula to validate you and say, “Yeah. That's totally fine. That's a great idea. You can go on in.” Kelsey: Yeah. Yeah. Absolutely. I think you have to take into account all of your experiences in the past too. What is going on in your life as you're experiencing this labor, as your baby is coming into this world? I kind of felt like I was taking a risk by having a VBAC. I know that I wasn't necessarily, but that was big enough for me so I needed to mitigate the other smaller risks by just going to the hospital and being in a place where I felt comfortable. That might not be the case for others listening and that's okay. Something else I decided fairly early on in my pregnancy was that I did not want to know how far dilated I was. I didn't want to know baby's station. I knew that this was a mental game, so whether I was a centimeter dilated upon admission or 6 centimeters, I just did not want to know. I wanted to do what my body was doing, lean into that. My husband was told how far dilated I was. He relayed that info to my doula until she was present and then obviously, my doctor knew as well. You mentioned at the beginning of the show, I was a certain centimeter dilated when I was admitted and that was 0. Meagan: Not dilated at all. Kelsey: Not dilated at all. Meagan: A lot of the time, with people who are wanting to VBAC, if you walk in with ruptured membranes, nothing is really happening, and you're not dilated at all, Pitocin doesn't help when not much is happening. It helps us dilate but usually, they want it to be something. Do you remember how effaced you were? Kelsey: I don't remember how effaced I was. I don't know if I even was at all. Meagan: Okay, yeah. See? And then right there, a provider sometimes might say, “There are no options here.” Kelsey: Yeah, and let me tell you. Because I was not having any contractions, I didn't know how dilated I was, but I do remember my labor and delivery nurse saying, “Because you're not having contractions, Pitocin is really your only option.” My doctor came in right after that and said, “I don't see why I can't insert a balloon catheter. He was the one who was like, “Wait a minute. I'm the doctor. I'll make that decision.” Meagan: Let's not let the nurse call the shots. That's good that they were willing to give you Pitocin because sometimes, we'll have providers say, “We'll try to give you Pitocin and try and help you efface and open just a little bit to help us get a Foley or a Cook in,” but some providers are like, “No. No contractions, no dilation, no effacement, rarely is Pitocin going to help.” But it can. Kelsey: We didn't do Pitocin yet. We started with a balloon catheter. Meagan: Can you tell people how uncomfortable or comfortable it was and how you could get through it? Because not dilated at all, you're literally putting a catheter through a closed, hard cervix. Kelsey: Absolutely. It was painful. It was painful getting it in, but the real painful part– and I'm sure that your listeners know and you'll have to correct me if I'm wrong– the balloons are inserted. They are pumped with saline to manually being to dilate the cervix. They fall out by themselves somewhere around 4 centimeters. Is that right? Meagan: 3-4 centimeters, yep. Kelsey: Putting it was painful, but the real pain came when my nurses would try to put some tension on the balloon to tug on it to see if it would come out. My husband will say, “That looked like it was the most pain that you were in the whole time.” That was so painful. And of course, I don't have an epidural at this point. It's not coming out, lady. It's not coming out. Give it a minute. So that was pretty painful. Meagan: Yeah. And they pull and push and put pressure on it to try and encourage it and see because sometimes it will just slip out but it also needs to come down and put pressure on the cervix but it's obviously not the funnest. But could you say manageable or worth it or would you say, “I'd never do it again in my life”?Kelsey: No, absolutely. No. I would absolutely do it again because it worked for me and really, only one of the balloons that came out was painful. I got up to use the restroom at about maybe 5:00 PM that night. It was inserted at 9:30 in the morning. I got up to use the restroom one time at 5 and the second one just popped out like that. It was easy peasy. So I would absolutely do it again. It was not that miserable but it was certainly not comfortable. Meagan: Yeah, not pleasant. Kelsey: Yeah. And I love what my doctor said. He came in whenever that second balloon fell out and he said, “You're dilated. We know you're dilated to a certain point at least.” I was very conservative with cervical checks. I was like, “You can check me when I'm admitted but other than that, I really don't want anyone up there,” because I know that increases the risk of infection. So he said, “There's no reason for me to check you. We know that you're at a certain point, but now we've got to work to get your contractions to match your dilation,” which was such an easy way for me to understand what was going on. And you'll have to forgive me because I don't remember when they started the antibiotic drip. I was diagnosed with GBS as we mentioned and I did choose to go the antibiotic route just because– and this takes into another point that we talked about earlier– I had a friend whose daughter did contract GBS during delivery and she was very, very sick, hospitalized the first week after she was born. So I knew statistically the odds were very small for my little one to experience any adverse consequences but that was a risk I just didn't want to take. I wanted to mitigate it. Meagan: And that's great. Kelsey: So I did take antibiotics. I don't know how much, but I did go that route. Meagan: Yeah, most people do. Most people do. Kelsey: Yeah. So we did begin to work to get contractions to match my dilation. I pumped a little bit. I moved around. We began Pitocin and this was honestly my favorite part of labor. I would do the hours from 5:00 PM to 10:00 PM when I did get an epidural over and over and over again. I put my headphones in. I got in the zone. I spent a lot of time on the birthing ball and on the toilet. When people say the toilet is a magical place to be when you're in labor, they're not wrong. They're not wrong. Meagan: I loved it too. I loved it. Kelsey: I loved it so much. Meagan: It was this weird way to put counterpressure, open the pelvis, take off the pressure, but also at the same time, get the good pressure. I don't know. I loved it too. Kelsey: Yes, and my doula had set up candles in the bathroom and the lights were turned off. It was a moment when I was unhooked from the machines. She had some essential oils in the toilet. I don't know. I never knew the hospital restroom could be so relaxing, but it was great. Meagan: I love that. Kelsey: It was so great. I did work through contractions for about 5 hours. I was getting so tired by this point. I had been up for 24 hours without a drop of sleep. I didn't have the same fortitude that I maybe would have had 12 hours prior, so I began to no longer work with my contractions. I was just fighting against them. I was yelling, “No” a lot. I was saying things that– I don't know. Laboring brings out a whole other individual within a woman I believe. At about 10:00 PM that night, Pitocin was up to a 5. I was dilated to about 7 centimeters and I decided to get the epidural which is something that I necessarily didn't plan on, but I'm glad that I did. It was a good decision. Meagan: I love that you say that because I think that there's so much shame sometimes about having this goal and desire, but then “giving up” which is not giving up, just to let you know, listeners. The epidural can really come in as such an amazing tool when you're exhausted. Sometimes we're holding so much tension, so getting an epidural actually offers relaxation. There are other pros and cons to epidurals, but the epidural can be such a great tool and you should never feel bad or question your decision to change your mind. Kelsey: Yeah, absolutely. And this is another thing that I learned as I was laboring or really reflecting on the labor and delivery process is that first of all, for the most part, none of your decisions have to be instantaneous and I remember my doula telling me this. She was like, “You can take a minute. You can ask everyone to step out of the room and it just be you and your husband. You can think through the pros, cons, risks, and advantages. For whatever decision you make, for the most part, you have time.” I was always afraid that I would be pressured into, “Okay, you're in here. We've got to make a decision. What do you want to do?” and I wouldn't know what to do. So I was so glad that there was time and that there were options. I feel like my epidural was one of those things. I remember asking everyone to leave the room and it was just me and my husband. We were talking through it, but it allowed me to rest. I got to sleep a little bit. Because of my doula and nurses, they positioned me just so that baby moved several stations. I dilated to 9 centimeters and I was 80% effaced in a matter of hours. Meagan: Wow. That is awesome. Kelsey: Yes, it was great. I still didn't know how far dilated I was until this point. My doula, nurse, and husband decided it would be– I mean, they let me make the ultimate decision, but they thought it would be a good idea to know that I was 9 centimeters because I was 24 hours into this thing and kind of discouraged to be quite honest. Anyway, we were quickly approaching the 24-hour mark since my water broke. That was another thing that I was starting to freak out about. I felt like, “Okay, because my water is broken and it's been 24 hours, this is going to be an automatic C-section,” but that was not the case. I remember– my doctor didn't really come to see me that much, but he just seemed so unbothered by it. Meagan: So what you're saying is that he didn't even treat you any differently? Kelsey: No, no. Meagan: That's amazing. That's amazing.Kelsey: He is so– if you're ever in the DFW area– Meagan: That's what we want. That is what we want. If you in your mind are like, “Oh, I've got this C-section. I've got this and I've got that,” and your provider is just acting like you are any other person coming in and having a baby, yeah. That's awesome. That's what you want. Kelsey: That's how my nurse was too. I remember telling her, “I'm so scared every time you come and take my temperature because I'm afraid that I'm going to have spiked a fever.” Meagan: That you'll say I have an infection, yeah. Kelsey: Yes. I remember she put her hands on my knees and she looked me in the eye and she said, “Even if I come in and you've spiked a fever, a C-section is not the only way to get this baby out. She's right there. She's right there. There are other options. It's going to be okay.” Meagan: Yes. That's awesome. Kelsey: So we just kept on keeping on. I slept. I kept sleeping a little bit. I rested from about 2:00 AM until 6:15 AM when I was complete. We started doing some practice pushes, but on the first practice one, the baby's head started coming out. Meagan: Ah! That first practice push. Kelsey: Yes, so my nurse was like, “Can you hold on a minute? Let me go get the doctor.” I'm pretty sure he came from home. This is probably one of those do as I say not as I do situations. I was so tired of waiting and I was so tired in general. I just started pushing even when contractions weren't necessarily helping me, but that girl came out in 30 minutes. She was born and put in my arms. It was the very best. I never heard a single, “Well, you've got Group B Strep or your waters have been broken this long.” I mean, none of that from my doctor, from nurses, no one. Meagan: Awesome. Kelsey: I feel like they treated me as an individual case because I was. I was not a textbook that they were reading in nursing school or medical school or anything like that. It was, “At this moment, how is your baby doing? How are you doing? What are the signs that we have from data and all of those kinds of things and experiences? I think we're okay to keep going.” So that's what we did. Meagan: I love that. This team sounds really awesome. Kelsey: They were great. Meagan: It would be really cool if we could just replicate them and send them all over the world. Kelsey: I know. They were awesome. Meagan: There are providers just like them for sure, but that just sounds so awesome and so non-pressuring especially when you have all of these little factors that could really impact a provider's view. Kelsey: Yeah. Meagan: Ah, it's so awesome. Well, I am so happy for you. Huge congrats. Huge congrats. Kelsey: Thank you. Thank you. Meagan: I'm so glad that along the way you were one, supported, and two, you were able to follow your heart and feel validated for following your heart, and being able to shift gears based on what you were giving. This is so important to know. Plans can change. Things can change and you didn't go with the same exact provider. A lot of the time, we do so that's another little tidbit I would like to talk about it providers and how important providers are and can really impact. This is even before having a C-section. From the get-go, right? If we have a provider that is really against vaginal birth in the beginning or really prone to induction and pressing and pushing Pitocin really hard and then we stress baby out and then we're not doing well and then we have a C-section, we needed to be supported and not pressed from the beginning. Know that if you are feeling these red flags as a first-time mom if you're listening because I know we have first-time moms listening. Know that if you're feeling weird about a provider, it's okay to change at any point. It's really okay. Find a provider like this that supports you and says, “Okay, this is what we've got. Everything is looking okay. Here we are. Let's keep going,” and really helps you as your guide. Kelsey: I remember there were two things. I guess I just want to rave about him more. Towards the end of my pregnancy, we were doing– oh gosh. What is it? A non-stress test. We were doing that at every appointment because of my blood clotting disorder and just making sure that baby was doing okay. My amniotic fluid level was kind of decreasing. It was getting pretty close to that line where most doctors would say, “Oh, it's getting too close. You've got to come in tomorrow. We're going to induce at 39 weeks.” He just said, “Oh, we'll check it again next week. Just make sure you're drinking a lot of water.”When I came in to be admitted, there was meconium because I had that rupture of membranes and there was meconium. It wasn't clear so I was freaking out and he said, “That's actually pretty normal for full-term. We're not going to be worried about it.” And I didn't know that!Meagan: Yeah. Yeah, it is. The longer-term the baby goes, it's common. I mean, it can happen really anytime, but yeah. Meconium is more common than the world knows. Kelsey: Absolutely. Absolutely. Meagan: There are so many babies that are born with meconium that the nurses and the staff pay attention to a little more after birth but have no complications. Kelsey: Yeah, yep. That's exactly what happened with us. Meagan: Yeah, yeah. That's important to know. Well, I want to talk a little bit about GBS. Let's talk about the actual evidence. The risk of a newborn getting a GBS infection– you kind of mentioned that it's pretty low, but based on your own experience you're like, “Yeah, it wasn't worth the risk to me.” It's the same thing when we're talking about TOLAC. Okay, uterine rupture risk is pretty low, but then we have to evaluate what risk is acceptable to that individual. Kelsey: Absolutely. Meagan: Not treating meaning no use of antibiotics which is usually Penicillin via IV and it's usually done about every 4 hours, especially after a rupture of membranes. The risk of serious infection including so serious death is 1-2%. Kelsey: Yeah. It's small. Meagan: It's very small, but again, it's what risk you are willing to take. Some people are 100% willing and say, “I would really rather not receive antibiotics,” and that is okay too. There's not a ton of evidence with Hibicleans and stuff like that. It's a vaginal wash. Honestly, it's like a douche. Sorry for saying that word everybody, but that's what it is. You put it on up there and it cleanses the canal. So the risk of infection with the treatment of antibiotics is about 0.2%. So, still very low.Kelsey: Also small.  Meagan: Also very small. But still, there you go. And then one thing that– and it's from a small trial and it was quite a few years ago. I think it was 7 years ago maybe in 2016. They did a small trial and they found that women that were GBS positive that took probiotics decreased their chance by 43%. 43% of them became GBS-negative by birth. Kelsey: Okay, interesting. Meagan: So really interesting. Probiotics. I believe in probiotics not even pregnant, just all the time. I think it's really a good thing because there is so much in our food and everything these days but that was kind of an interesting thing. Again, like I said, it was a smaller trial. It was done quite a few years ago, but 43% of them became negative by birth. That's pretty high. Kelsey: Absolutely. Meagan: 43%. So knowing also that if you test positive, you can retest closer to birth because it can go away. It doesn't always though, so don't think that if you get positive and you start probiotics that you are for sure not going to be positive, but know that there are things that you can do or the garlic and things like that. We'll have a blog in the show notes today linked about GBS. We'll have these trials and things linked as well so you can go check them out for yourself and make the best decision for you. Kelsey: Yeah, I think it goes without being said too that there is going to be a risk with antibiotics as well. Where there is risk, there has to be choice. I made my decision but probably hundreds of thousands of women listening to this are going to choose differently. Meagan: Yeah. Yeah, and that's okay. That's one of my favorite things about this show. We all have opinions and we all have things that we would do versus someone else, but there's no shaming in any decisions that anyone makes. I was actually never GBS positive so I never even had to make that choice which I'm grateful for. A lot of people will say, “No. No way. I don't want antibiotics because there's risk with antibiotics.” But then a lot of people will say, “Well, I'd rather have the risk of taking the antibiotics than this risk too.” So you just have to weigh out the pros and cons and decide what's best for you. But yeah. I love your story. I love that you had a long birth, premature rupture of membranes, walking in at no dilation, and a less-ideal cervical state. Kelsey: Yes. Adding that to my resume. Meagan: A less-than-ideal cervical state with my VBAC. And a Cook catheter and that took time and all of the things. Here you are and you had a vaginal birth. Kelsey: I did. I did. I would do it all over again. Meagan: A lot of people ask me that. “Would you do it again?” because I had a really long labor as well and I'm like, “Yeah. Yep. I totally would do it again. 100%. Absolutely.” Well, thank you so much for being with us today and sharing your story. Kelsey: Thank you for having me. It was great. ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan's bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands

Show notes at pharmacyjoe.com/episode830. In this episode, I'll discuss using heparin anti-Xa levels to evaluate apixaban, rivaroxaban, fondaparinux, and danaparoid levels. The post 830: Using Heparin Anti-Xa Levels to Evaluate Apixaban, Rivaroxaban, Fondaparinux, or Danaparoid Levels appeared first on Pharmacy Joe.

Show notes at pharmacyjoe.com/episode830. In this episode, I ll discuss using heparin anti-Xa levels to evaluate apixaban, rivaroxaban, fondaparinux, and danaparoid levels. The post 830: Using Heparin Anti-Xa Levels to Evaluate Apixaban, Rivaroxaban, Fondaparinux, or Danaparoid Levels appeared first on Pharmacy Joe.

Show notes at pharmacyjoe.com/episode819. In this episode, I'll discuss the duration of DOAC interference with heparin anti-Xa levels. The post Episode 819: Duration of DOAC interference with heparin anti-Xa levels appeared first on Pharmacy Joe.

Show notes at pharmacyjoe.com/episode819. In this episode, I ll discuss the duration of DOAC interference with heparin anti-Xa levels. The post Episode 819: Duration of DOAC interference with heparin anti-Xa levels appeared first on Pharmacy Joe.

The following episode begins the discussion of anticoagulation. The discussion includes the mechanism of action, routes of administration, dosing, initiation consideration, lab values (aPTT vs Xa), side effects, and reversal. The episode also examines the difference between heparin and low molecular weight heparin.    For further reading: https://emcrit.org/ibcc/heparin/ https://emcrit.org/ibcc/reverse/ https://emcrit.org/ibcc/thrombocytopenia/    

Editor's Summary by Linda Brubaker, MD, MS, Senior Editor of JAMA, the Journal of the American Medical Association, for the April 4, 2023, issue. Related Content: Audio Highlights

Show notes at pharmacyjoe.com/episode798. In this episode, I’ll discuss an article about using bivalirudin for anticoagulation during ECMO. The post 798: Bivalirudin: Better AND Cheaper Than Heparin for ECMO? appeared first on Pharmacy Joe.

Show notes at pharmacyjoe.com/episode798. In this episode, I’ll discuss an article about using bivalirudin for anticoagulation during ECMO. The post 798: Bivalirudin: Better AND Cheaper Than Heparin for ECMO? appeared first on Pharmacy Joe.

Get a free nursing lab values cheat sheet at NURSING.com/63labs   What is the Lab Name for Partial Thromboplastin Time (PTT) Lab Values? Partial Thromboplastin Time   What is the Lab Abbreviation for Partial Thromboplastin Time? PTT   What is Partial Thromboplastin Time in terms of Nursing Labs? Partial Thromboplastin Time (PTT)evaluates the function of factors I, II, V, VIII, IX, X, XI, and XII. PTT represents the amount of time required for a fibrin clot to form. Monitors therapeutic ranges for people taking Heparin.   What is the Normal Range for Partial Thromboplastin Time? 25 – 35 seconds   What are the Indications for Partial Thromboplastin Time? Detection of coagulation disorders Evaluate response to Heparin (PT for Coumadin) Preoperative assessment   What would cause Increased Levels of Partial Thromboplastin Time? Disseminated Intravascular Coagulation (DIC) Clotting Factor Deficiencies: Hypofibrinogenemia Von Willebrand Disease Hemophillia Liver disease: Cirrhosis Vitamin K deficiency Polycythemia Dialysis   What would cause Decreased Levels of Partial Thromboplastin Time? N/A

Aspirin ist eines der bekanntesten Medikamente der Welt. Das Schmerzmittel hat noch einige zusätzliche Wirkungen, das ist bekannt - unerwünschte, aber auch erwünschte, wie sich jetzt zeigt. Es verschlechtert etwa die Blutgerinnung. Diese Eigenschaft macht Aspirin zu einem hoffnungsvollen Kandidaten, um Thrombosen vorzubeugen. Wie das funktioniert, erklärt Wissenschaftsjournalist Moritz Pompl.

Show notes at pharmacyjoe.com/episode768. In this episode, I'll discuss how propofol appears to interfere with monitoring heparin using aPTT. The post 768: Propofol appears to interfere with monitoring heparin using aPTT appeared first on Pharmacy Joe.

Show notes at pharmacyjoe.com/episode768. In this episode, I ll discuss how propofol appears to interfere with monitoring heparin using aPTT. The post 768: Propofol appears to interfere with monitoring heparin using aPTT appeared first on Pharmacy Joe.

Systemic Lupus Erythematosis is several-fold more common in women than in men. As it primarily targets reproductive age women, identification of and proper management of patients with associated antiphospholipid antibodies is crucial to improve maternal and neonatal outcomes. In this episode, we will review the 2019 ACR diagnostic criteria for SLE and review the management of SLE patients with/without antiphospholipid antibodies and with/without antiphospholipid antibody syndrome.

GuestParth Rali, MD Temple University HostJennifer D. Duke, MD Mayo ClinicP.J. Gary, MD Mayo ClinicShow Notes If you enjoyed this content, please follow or subscribe and leave us a review!  Access the ATS Reading List. Recommended Reading  Konstantinides S, Geibel A, Heusel G, et al. Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism. N Engl J Med 2002; 347:1143-50.  Meyer G, Vicaut E, Danays T, et al. PEITHO investigators. Fibrinolysis for patients with intermediate-risk pulmonary embolism. N Engl J Med 2014; 370:1402-11. Supplement to: Meyer G, Vicaut E, Danays T, et al. Fibrinolysis for patients with intermediate-risk pulmonary embolism. N Engl J Med 2014;370:1402-11. DOI: 10.1056/NEJMoa1302097 Rali P, Criner GJ. Submassive Pulmonary Embolism. Am J Respir Crit Care Med 2018; 198(5):588-98.  Chaudhury P, Gadre SK, Schneider E, et al. Impact of multidisciplinary pulmonary embolism response team availability on management and outcomes. Am J Cardiol 2019; 124:1465-69.  Konstantinides S, Vicaut E, Danays T, et al. Impact of Thrombolytic Therapy on the Long-Term Outcome of Intermediate-Risk Pulmonary Embolism. J Am Coll Cardiol. 2017 Mar, 69 (12) 1536–1544.

Show notes at pharmacyjoe.com/episode762. In this episode, I'll discuss four potential reasons for a false heparin anti-Xa level. The post 763: Four possible causes of a false heparin anti-Xa level appeared first on Pharmacy Joe.

Show notes at pharmacyjoe.com/episode762. In this episode, I ll discuss four potential reasons for a false heparin anti-Xa level. The post 763: Four possible causes of a false heparin anti-Xa level appeared first on Pharmacy Joe.

Why can heparin cause hyperkalemia? On this episode of The Curious Clinicians, they explore that question and many more fun facts about this age old anticoagulant. Check out the show notes here. Click here to obtain AMA PRA Category 1 Credits™ (0.5 hours), Non-Physician Attendance (0.5 hours), or ABIM MOC Part 2 (0.5 hours). Audio edited by Clair Morgan of Nodderly.com.

Trade – Unfractionated Heparin Class – Anticoagulant MOA – Acts on antithrombin III to reduce the ability of the blood to form clots, thus preventing clot deposition in the coronary arteries. Indication – ACS, acute pulmonary embolism, DVTContraindication – Predisposed to bleeding, aortic aneurism, peptic ulcer. Dosing:AdultCardiac indications – 60 units/kgPulmonary embolism/ DVT – 80 units/kgPediCardiac indications – 75 units/kgPulmonary embolism/DVT 75 units/kg

Download the cheat: https://bit.ly/50-meds  View the lesson: https://bit.ly/HeparinHep-LockNursingConsiderations      Generic Name heparin Trade Name Hep-Lock Indication Venous thromboembolism prophylaxis and treatment, low dose used to ensure patency of IV catheters Action increases the inhibitory effect of antithrombin on factor Xa Therapeutic Class anticoagulant Pharmacologic Class antithrombotic Nursing Considerations • monitor for signs of bleeding • monitor platelet count • may cause hyperkalemia • have patient report any signs of bleeding

(01:51) Can you give a brief overview of the assay you developed and how it works?(06:28) The serotonin release assay is utilized within five to 14 days of heparin exposure. Is there a subsequent time when this test would be utilized?(10:28)  How does this assay improve upon previous approaches?(12:58) Is there greater specificity and sensitivity with the use of nonradioactive materials?(13:46) What interesting findings have we had through the process of developing and validating this assay?

“Saline is very benign and doesn't have any risk of harm for the patient. They're small doses, so we're not worried about sodium or anything. The risk of heparin is actually quite extensive,” MiKaela Olsen, DNP, APRN-CNS, AOCNS®, FAAN, clinical program director in oncology at Johns Hopkins Hospital and Johns Hopkins Health System in Baltimore, MD, told Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS, during a conversation about the latest evidence surrounding central venous catheter flushing solutions and techniques. You can earn free NCPD contact hours after listening to this episode by completing the evaluation linked below. Music Credit: “Fireflies and Stardust” by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Earn 0.75 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at myoutcomes.ons.org by July 29, 2024. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. Episode Notes Check out these resources from today's episode: Complete this evaluation for free NCPD. ONS Access Device Standards Oncology Nursing Podcast Episode 127: Reduce and Manage Extravasations When Administering Cancer Treatments Episode 162: What Nurses Need to Know About Central Lines and Ports Clinical Journal of Oncology Nursing articles Heparin Versus Normal Saline: Flushing Effectiveness in Managing Central Venous Catheters in Pediatric Patients With Cancer Heparin Versus Normal Saline: Flushing Effectiveness in Managing Central Venous Catheters in Patients Undergoing Blood and Marrow Transplantation Implanted Port Patency: Comparing Heparin and Normal Saline Central Venous Access Devices: An Investigation of Oncology Nurses' Troubleshooting Techniques ONS books Access Device Standards of Practice for Oncology Nursing Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice Journal of Vascular Access article: Flushing of Intravascular Access Devices (IVADS) – Efficacy of Pulsed and Continuous Infusions Medical Devices: Evidence and Research article: Pulsative flushing as a strategy to prevent bacterial colonization of vascular access devices ASCO/ONS Chemotherapy Administration Safety Standards ONS/ONCC Chemotherapy Immunotherapy Certificate Course Infusion Nurses Society's Infusion Therapy Standards of Practice To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From Today's Conversation “The way that you can eliminate heparin is by really focusing on education and teaching of patients and nurses and other staff that access central lines about how to do that.” Timestamp (TS) 06:13 “One of the barriers right now I think is that a lot of the manufacturer guidelines are old, and they still recommend in their catheter guidelines to use heparin because they aren't up to date either.” TS 07:50 “The risk of heparin is actually quite extensive. For instance, we know that heparin can cause heparin-induced thrombocytopenia, or HIT. Unfortunately, you don't always know that your patient is experiencing that, but I've had many, many patients over the years where, all of a sudden, their platelet count was low, and no one knew why. . . . We did testing for HIT and found out that it was the heparin flushes that were causing that.” TS 09:04 “Normal saline is the most benign solution that can be used in catheters. There are studies showing benefit in some patient populations, and I know that some places have protocols using an antibiotic lock solution or a sodium citrate lock solution, but in general the most common type of flush solution for central lines as heparin begins to move out of favor is normal saline.” TS 13:06 “We know that using a push-pause, pulsatile, or, I call it sometimes, turbulent flush, has been shown to promote the clearance of the catheter lumen and prevent occlusion. According to the Infusion Nursing Society guidelines. . . . we are instructed to stop and start every millimeter of flush. . . . That is really important because every time you stop and start, you cause turbulence in that catheter.” TS 13:55 “When you study it, you find that patients or nurses are not actually flushing enough. If the patient's at home and you're using saline, then the catheter is usually flushed on a daily basis with pulsation when not in use. If the patient's giving themselves antibiotics or other medications through their catheter, they need to be taught how to do the saline flush after each of the medications.” TS 17:47

Emergencies happen in hematology and oncology. This is a fact. But how do we manage these emergencies? Look no further. In this episode, we talk all about our third hematologic emergency: heparin-induced thrombocytopenia (HIT)!Be sure to check out episode 009 on thrombocytopenia for a general approach and differential!HIT:- Any time a patient with heparin exposure and now with a new thrombotic event, you need to think about HIT!What is HIT?- Type 1: a transient drop in platelets after heparin is started- Type 2: **The scary one! Antibody-mediated process**Heparin molecules bind to platelet-factor 4 (PF4)**This complex activates platelets, which then further releases more PF4 from the plateletsWhat is the difference between HIT and HITT?- HITT is when there is also thrombosis (HIT + Clot) Why is this more common in the cardiac ICU?- It is believed that IgM interacts with ultra-long complexes, which heparin is- Lots of heparin is required for cardiac surgery- Therefore lots of exposure to heparin increases likelihood, increasing likelihood for IgM to IgG class-switching; HIT is IgG-mediated process** Remember - since this is antibody-mediated, therefore it takes a few days for the antibodies to form in patient with a new diagnosis of HIT!How to stratify?4-T score (MDCalc Link: https://www.mdcalc.com/4ts-score-heparin-induced-thrombocytopenia)Workup: - Sent HIT ELISA test in patient with high suspicion - ELISA just suggests if the HIT antibody is present- If ELISA positive, then do confirmatory assay, i.e., is this antibody actually doing anything, is the "serotonin-release assay” - Send 4 extremity dopplers to look for thrombosis - STOP heparin/heparin-derived products and SWITCH anticoagulant, such as argatroban, fondaparinux, bivalirudin (do not wait for a positive test if your suspicion is high enough!)If HIT positive: - Add heparin to their allergy list- Continue anticoagulation until platelets are recovered (>150K)- Continue anticoagulation for 3-6 months for patients with HITTWords of wisdom: If patient comes from outside hospital and starts having decreasing platelets, consider HIT in your differential! References: https://ashpublications.org/blood/article/119/10/2209/29530/How-I-treat-heparin-induced-thrombocytopenia- great review article from ASH on HITPlease visit our website (TheFellowOnCall.com) for more information Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast

Emergencies happen in hematology and oncology. This is a fact. But how do we manage these emergencies? Look no further. In this episode, we talk all about our first hematologic emergency: immune thrombocytopenic purpura (ITP).Immune thrombocytopenic purpura (ITP):Be sure to check out episode 009 on thrombocytopenia for a general approach and differential!Specific instances where there may be close to undetectable platelet count: * Lab artifact (clumping)* Very severe DIC* Thrombotic thrombocytopenic purpura - though usually higher platelets in these cases * Heparin induced thrombocytopenia (in very severe cases) - though usually higher platelets in these cases * ITP ITP: Diagnosis of exclusion How to confirm it is ITP?* Post-transfusion CBC - a repeat CBC 30-60 mins after a platelet transfusion. In ITP, the platelet count will likely not budge. (Not perfect test!)* Immature platelet fraction (if available) - this will be elevated if mature platelets are being destroyed. (Again - not a perfect test) Treatment in acute cases: IVIG 1g/kg daily x2 days + Dexamethasone 40mg daily x4 daysReference:https://ashpublications.org/blood/article/106/7/2244/21649/How-I-treat-idiopathic-thrombocytopenic-purpura - Great How I Treat article from Blood Please visit our website (TheFellowOnCall.com) for more information Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast