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I absolutely love your videos!!! I'm a new grad in the ICU and your videos are very informative!!! I do have a request, is it possible to make a video on proper trach care, the different sizes/types, and what to do if it comes out please?
I JUST started as a fresh grad RN in the ICU, and safe to say it's been quite challenging adjusting to the RN lifestyle, much less an ICU RN. But your videos have given me such a confidence boost knowing that I'm learning new info for my practice, instead of waiting around to encounter something totally new that would otherwise have me in a confused panic hahaha. Much appreciated and love to see your videos!
So cool! Yeah the hope is to provide the info in a way that makes sense and hopefully help in your understanding when you do encounter something again. Glad you find them helpful!
Yes! I do have both EVD and covering ICPs as topics on the todo list. Hopefully sooner than later. Probably won't specifically cover the Camino or Bolt devices themselves, but the ICP concepts around it.
Heparins act a little bit on factor X and Xa and acts a lot on thrombin in the clotting cascade. APTT checks multiple clotting factors and has a wider margin. Anti Xa has a very tight "heparin specific" margin. Since most of the action happens on thrombin, if the anti Xa level is monitored during heparin infusion, it's more reliable and accurate to measure small differences in tenths of a unit, rather than a range of 30-40 whole seconds. Compare to measuring 3cc medication in a 20cc syringe versus a 5cc syringe. Somehow that's what helped make it make sense in my head.
Mamadelosgatos answered pretty well! Just to expand on it, aPTT is pretty unspecific general evaluation of the intrinsic and common pathways of the clotting cascade. That said, these pathways are also influenced by many other factors besides just the effect of heparin, including various biological mechanisms that could be going on, especially in the critically ill. Anti-Xa is more specific to the effects of Heparin on this clotting as Factor Xa is bound by the antithrombin-heparin complex, preventing its availability in the clotting cascade. Studies have shown that using anti-Xa to monitor Heparin infusions leads to shorter times to therapeutic levels and reduces the number of dosing adjustments that are needed. TLDR Anti-Xa is more specific for heparin and quicker to achieve therapeutic goals.
I thought the one inaccuracy would be that renal function does NOT matter and it is the anticoagulation of choice in patients with super low renal function?
Good question Nadia. Typically what drives our suspecting HIT is a drop in platelets for someone on heparin, and typically this is without a drop in Hgb/Hct. I haven't personally seen it, but we can see rashes at injection site, redness and swelling in extremities, and new clot formation or enlargement due to the hypercoagulable state. That said, every time I've seen it, the suspicion started with dropping platelets.
What I am trying to figure out is the difference between iv pushing heparin and subcutaneous. On the vial it states IV or SQ use, not hep lock. So how does either effect the body differently?
Slower absorption SQ. Smaller dose, but can be slow absorbed into system circulation over time. This is why we can use this as DVT prophylaxis but not doing that as single IV push.
so when im starting heparin, I say to the pt, "this is to prevent any other clots from forming! :) " and he says, "well what about the one I already have?" im like errrrrr welp we shall find out together soon lol but then I never find out 😂 they dont stick around in the ER that long. Some clots stay with the pt for life though, hmm?
Good question! So the body will naturally break down clots over time. Large, mature clots may take a long time, or need either removal (surgical or Cath) or through thrombolysis (think TPA). Giving heparin to those with clots already, such as PE, helps to prevent formation of new clots AND also helps to prevent further enlargement of the clot already present.
❤ Show your support with an ICU Advantage sticker! 👉🏼 adv.icu/support
💲 10% off EACH Month @ Nurisng Mastery membership: 👉🏼 adv.icu/mastery
NOTES for this lesson (and all previous lessons) are availably only to TH-cam and Patreon members. Links to join both here ⬇
► TH-cam: adv.icu/ym | ► Patreon: adv.icu/pm
I absolutely love your videos!!! I'm a new grad in the ICU and your videos are very informative!!! I do have a request, is it possible to make a video on proper trach care, the different sizes/types, and what to do if it comes out please?
I JUST started as a fresh grad RN in the ICU, and safe to say it's been quite challenging adjusting to the RN lifestyle, much less an ICU RN. But your videos have given me such a confidence boost knowing that I'm learning new info for my practice, instead of waiting around to encounter something totally new that would otherwise have me in a confused panic hahaha. Much appreciated and love to see your videos!
So cool! Yeah the hope is to provide the info in a way that makes sense and hopefully help in your understanding when you do encounter something again. Glad you find them helpful!
New critical Care Paramedic, appreciate your videos! Especially this series!
Thank you for this very informative review. You provided me with a very quick review of the medication. More power to you.
You're very welcome!
ER nurse. This is so helpful as a new grad.
Awesome and congrats on the new ED gig!
Thanks , Sir !
Good lecture and good lecturer
Thanks Mohammad!
We use this all the time in the cath lab, great video!
Oh yes! Thank you!
Great icu teacher... You are the best... Mwalimu Asante Sana 🇰🇪🇰🇪❤️❤️
Thank you!
Love these videos! Thank you for such great content!
So glad to hear you love them Sophie and that they are helpful
Keep it up bubba! I appreciate your time to making such good info to review
Thanks! Will do and glad you enjoyed it!
Thank you for this video! Can you do a video next on TPA administration in stroke patients?
I do have a video already talking about TPA, but more just as a med review.
@@ICUAdvantage I am starting a job soon in the neuro intensive care unit so your videos are super helpful. Thanks alot!
Yeeees im the first one here. Thank you so much for all these videos!! Sooo helpful!!!
Nice! And you are very welcome. Thanks for your support!
Thank you for this! Very comprehensive.
Glad it was helpful!
Thank you🙏
Thank you! You do an amazing job!!!
Thank you. I appreciate that!
You are amazing 🤩 so smart.
Need a video for EVD/Camino’s!
Yes! I do have both EVD and covering ICPs as topics on the todo list. Hopefully sooner than later. Probably won't specifically cover the Camino or Bolt devices themselves, but the ICP concepts around it.
What is the advantage to ordering an Anti-Xa as opposed to an APTT? Thanks.
Heparins act a little bit on factor X and Xa and acts a lot on thrombin in the clotting cascade. APTT checks multiple clotting factors and has a wider margin. Anti Xa has a very tight "heparin specific" margin. Since most of the action happens on thrombin, if the anti Xa level is monitored during heparin infusion, it's more reliable and accurate to measure small differences in tenths of a unit, rather than a range of 30-40 whole seconds.
Compare to measuring 3cc medication in a 20cc syringe versus a 5cc syringe. Somehow that's what helped make it make sense in my head.
Mamadelosgatos answered pretty well!
Just to expand on it, aPTT is pretty unspecific general evaluation of the intrinsic and common pathways of the clotting cascade. That said, these pathways are also influenced by many other factors besides just the effect of heparin, including various biological mechanisms that could be going on, especially in the critically ill.
Anti-Xa is more specific to the effects of Heparin on this clotting as Factor Xa is bound by the antithrombin-heparin complex, preventing its availability in the clotting cascade. Studies have shown that using anti-Xa to monitor Heparin infusions leads to shorter times to therapeutic levels and reduces the number of dosing adjustments that are needed.
TLDR Anti-Xa is more specific for heparin and quicker to achieve therapeutic goals.
I thought the one inaccuracy would be that renal function does NOT matter and it is the anticoagulation of choice in patients with super low renal function?
36th like by me
Love from nepal
The way u explain amazing 💖
Woohoo!! Thank you Sushma. How cool.
Awesome, thanks much~!
You're welcome David!
This might be a silly question but what exactly is a "Unit?" How do units compare to a mcg/mg/g and why is "unit" used over mg/g?
How do we compute is it's a continous drip?
Good review, thank you. How would i, as a nurse, see HIT present itself clinically though? If bleeding is rare
Good question Nadia. Typically what drives our suspecting HIT is a drop in platelets for someone on heparin, and typically this is without a drop in Hgb/Hct.
I haven't personally seen it, but we can see rashes at injection site, redness and swelling in extremities, and new clot formation or enlargement due to the hypercoagulable state.
That said, every time I've seen it, the suspicion started with dropping platelets.
@@ICUAdvantage Thank you very much for your response and great content :)
Truly my pleasure 😊
Hi. Thank you for great lectures. What is your target anti-Xa level?
Glad you enjoyed it!
Anti-Xa goal is 0.3-0.7 IU/ml
What I am trying to figure out is the difference between iv pushing heparin and subcutaneous. On the vial it states IV or SQ use, not hep lock. So how does either effect the body differently?
Slower absorption SQ. Smaller dose, but can be slow absorbed into system circulation over time. This is why we can use this as DVT prophylaxis but not doing that as single IV push.
so when im starting heparin, I say to the pt, "this is to prevent any other clots from forming! :) " and he says, "well what about the one I already have?" im like errrrrr welp we shall find out together soon lol but then I never find out 😂 they dont stick around in the ER that long. Some clots stay with the pt for life though, hmm?
Good question! So the body will naturally break down clots over time. Large, mature clots may take a long time, or need either removal (surgical or Cath) or through thrombolysis (think TPA). Giving heparin to those with clots already, such as PE, helps to prevent formation of new clots AND also helps to prevent further enlargement of the clot already present.
👍👍
TY!