Subq heparin and single shot nerve blocks

[AKMD_1984]

Hi this may seem like an elementary question but can you please share any nice resource discussing specifically if it’s safe to give subq heparin for Dvt prophylaxis before a peripheral nerve block? (No epidural or spinal).

Previous hospital I was at - they would give subq heparin after the peripheral block (truncal, upper extremity, lower extremity even PVB) was done, there was no issue as it was felt that there is no catheter.

What’s the quick and dirty answer? I’m having a hard time finding a tabular form pdf online specifically for ultrasound guided peripheral nerve blocks (I’ve typically used Uwash neuraxial guidelines)

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[coffeebythelake]

It is fine. For prophy subq heparin doses 5000 bid it is fine to give before peripheral blocks and even with neuraxial. Heck we do some peripheral blocks on patients even if they are on therapeutic AC

 

[coffeebythelake]

Neuraxial Anesthesia and Peripheral Nerve Blocks in Patients on Anticoagulants - NYSORA

The decision to perform neuraxial anesthesia or peripheral nerve blocks in patients on anticoagulants, should be made on an individual basis, weighing the benefits of regional anesthesia against the risks. Intraspinal hematoma is a relatively rare condition resulting from a variety of causes...

www.nysora.com

 

[nimbus]

The thing that worried me was systemic heparinization 1 hour after inserting a lumbar drain with a 14g tuohy. Never felt great about that but so far no problems.

 

[JoelJoel84]

There is an excellent app from ASRA called Coags which is really helpful; you enter either regional or neuraxial access, and click on the anticoagulation status and medication to see the most current guidelines.

 

[coffeebythelake]

The thing that worried me was systemic heparinization 1 hour after inserting a lumbar drain with a 14g tuohy. Never felt great about that but so far no problems.

As long as we aren't manipulating the drain, pulling it back, making adjustments, etc. We have pregnant patients with HELLP that get epidurals for induction of labor before their platelet counts dip, and when they dip we leave the epidural in until the counts recover. Same idea with systemic heparinization.

 

[coffeebythelake]

The thing that worried me was systemic heparinization 1 hour after inserting a lumbar drain with a 14g tuohy. Never felt great about that but so far no problems.

Now specific to your example, i believe the recommendations for lumbar drains are to hold systemic heparinization for several hours if it is a bloody tap.

 

[nimbus]

Now specific to your example, i believe the recommendations for lumbar drains are to hold systemic heparinization for several hours if it is a bloody tap.

Yes that’s true…or come back the next day. Fortunately never had a bloody tap putting one in.

 

[AKMD_1984]

Thank you all. I appreciate it.