AAA & Heparin

[Anastezja]

How will you give heparin 5000 during AAA? IV bolus directly to CVP with a flush or to the IV line connected to CVP and running LR ?

How much time will you give to circulate before is safe for surgeon to place clamp?

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[VentdependenT]

http://www.anesthesia-analgesia.org/cgi/reprint/92/6/1391.pdf

 

[Noyac]

http://www.anesthesia-analgesia.org/cgi/reprint/92/6/1391.pdf

I didn't read the whole thing but isn't this study dealing with much larger doses (200u per kg)?

I typically give it via central line and wait 3 min. Is this wrong?

 

[VentdependenT]

I didn't read the whole thing but isn't this study dealing with much larger doses (200u per kg)?

I typically give it via central line and wait 3 min. Is this wrong?

You are totally right dude. My bad.

We wait 5 minutes at my institution. Why? Dunno.

 

[Anastezja]

What could be the reason of clotting in all arteries distal to the crossclamp?

 

[VentdependenT]

What could be the reason of clotting in all arteries distal to the crossclamp?

Inadequate dose of heparin? Heparin resistance? You could grab an ACT to rule that out. If your in the 250-300 range (from what I've read) then the culprit wasn't heparin.

 

[Noyac]

You are totally right dude. My bad.

We wait 5 minutes at my institution. Why? Dunno.

I love it when I'm right and I love it more when others know it.

I wait 3 minutes b/c thats how we did it at my institution.

I just never found it important enough to research. Maybe I'm wrong?

 

[rsgillmd]

I didn't read the whole thing but isn't this study dealing with much larger doses (200u per kg)?

I typically give it via central line and wait 3 min. Is this wrong?

Same at my hospital. 3 minutes after giving the heparin, draw an ACT. ACT around 300 --> good to go.

Same thing for the cardiac cases, except obviously doses and desired values are different.

I've never had a problem so far (crossing my fingers as I type) with this method.

 

[Planktonmd]

3 minutes seems to be the magic number everywhere.
And I don't think anyone is going to change their practice even if a study shows that 1 minute is enough.