BLOOD COAGULATION STUDIES

PTProthrombin Time; Pro Time; Protime aPTT/PTTActivated Partial Thromboplastin Time INRInternational Normalized Ratio

WHAT DO THESE LAB TESTS MEASURE?

PT and INR
Prothrombin Time and International Normalized Ratio

The PT test measures how long it takes for a clot to form in the sample of blood
The reagents that are used to perform these tests vary from lab to lab. This causes normal values to fluctuate INR with PT tests was set by the World Health Organization (WHO) to standardize the results across the world.

WHAT DO THESE LAB TESTS MEASURE?

aPTT or PTT
Activated Partial Thromboplastin Time

The PTT test measures the functionality of the intrinsic and common pathways of the coagulation cascade.

WHY ARE THESE LABS ORDERED?

PT and INR
Prothrombin Time and International Normalized Ratio

aPTT or PTT
Activated Partial Thromboplastin Time

Detect how well the patients blood thinning medication is working to prevent blood clots

To monitor standard heparin anticoagulant therapy To investigate an episode of unexplained bleeding or thrombotic episode.

To confirm a patients blood clotting status prior to surgery

WHAT IS THE NURSING RESPONSIBILITY?

PRETEST PREPARATION OVERVIEW Perform hand hygiene Identify patient Assemble all equipment and supplies Put on clean gloves Explain procedure to patient

y

Explain that mild and brief discomfort may be felt Verify (if required) that fasting has taken place

WHAT IS THE NURSING RESPONSIBILITY?

PRETEST PREPARATION (SPECIFIC) aPTT/PTT
y

PT and INR
y

* If the patient is receiving heparin by intermittent injection plan to draw the specimen 30-60 minutes before the next dose. * With a continuous heparin infusion, specimen can be drawn at anytime

Explain to patient there is no need to fast before the procedure. *If the patient receiving warfarin, the specimen must be taken before given the daily dose.

WHAT IS THE NURSING RESPONSIBILITY?

SUPPLIES NEEDED Gloves Alcohol Blue-Top (Sodium Citrate) Tubes Tourniquet Needle Gauze Bandage/Tape Labels for Tube

WHAT HAPPENS INTRATEST? GENERAL OVERVIEW

Position patient to access the anticubital fossa Ask patient to make a fist to distend veins Select vein for venipuncture Apply a tourniquet above the puncture site Cleanse site with alcohol, and allow to dry Perform venipuncture at a 15-degree angle to the skin Ease the Vacutainer tube forward in the holder as soon as the needle is in the holder When tube is filled, remove. Another tube may be inserted into holder Release the tourniquet when the blood flow begins Properly dispose of contaminated materials List on lab slip any drug that the patient is taking that may affect the test results.

WHAT HAPPENS INTRATEST? HTTP://WWW.YOUTUBE.COM/WATCH?V=_8ZSQXFQ VQM

The nurse collects a venous blood specimen from the patients arm, filling the vacuum tube.
The Blue-Top vacuum tube must be filled completely to ensure a proper blood-to-anticoagulant (sodium citrate) ratio. y The sample should be immediately mixed by gently inverting the tube back and forth to ensure adequate mixing of the anticoagulant with the blood. y Properly dispose of contaminated materials y List on lab slip any drug the patient is taking that may affect test results
y

WHAT HAPPENS POSTTEST?

aPTT/PTT

PT and INR

Pressure or a pressure dressing is applied to venipuncture site. The site must be monitored for bleeding.
y

*Bleeding time will be increased if patient is receiving anticoagulants or has coagulopathies

The nurse must also check for blood in the urine and all other excretions and assess the patient for bruises, petechiae, and bleeding gums.

Apply pressure to the venipuncture site and assess site for bleeding. If severe bleeding occurs, the anticoagulant effect of warfarin can be reversed by the slow parenteral administration of Vitamin K. If coagulation must be returned to normal more quickly, plasma can be given.

WHAT ARE THE EXPECTED VALUES?

MANY HOSPITALS ARE NOW REPORTING PT TIMES IN BOTH ABSOLUTE AND *INR NUMBERS

aPTT/PTT

PT and INR

y

Normal Values

y y

aPTT: 30-40 seconds PTT: 60-70 seconds Patients receiving Heparin, expect results 1.5-2.5 seconds greater than normal Critical Values
1

Normal Values

aPTT: < 50 seconds, therapeutic anticoagulation may not have been met and more heparin is needed aPTT: > 100 seconds, shows too much heparin has been given; risk for serious spontaneous bleeding exists.

PT: 11.0-12.5 seconds y *INR: 0.8-1.1 Patients receiving Coumadin, expect results 1.5-2.5 greater than normal 1 Critical Values:
PT: > 20 seconds 1 INR: > 5.5 * report for patients on anticoagulant drugs
1

INTERFERING FACTORS
aPTT/PTT PT and INR

Prolonging Factors Antihistamines Ascorbic acid Chlorpromazine Heparin Salicylates

Prolonging Factors Alcohol intake Diarrhea Shortening Factors A diet high in leafy green vegetables

WHAT MAY CAUSE AN INCREASE OR DECREASE IN RESULTS?

aPTT/PTT

PT and INR

y y y y y y y y

Increase

Increase

y y y y y y

Congenital clotting factor deficiencies, cirrhosis of liver, vitamin K deficiency Disseminated intravascular coagulation (DIC Heparin administration Coumarin administration

Liver disease Hereditary factor deficiency Vitamin K deficiency Bile duct obstruction Coumarin ingestion, Disseminated intravascular coagulation (DIC) Massive blood transfusion Salicylate intoxication.

Decrease

Early stages of DIC, Extensive cancer.

Decrease N/A

REFERENCES
AASN. (18 June 2010). PT and INR. Lab tests online. Retrieved September 29, 2010, from http://www.labtestsonline.org/understandin g/analytes/pt/test.html AASN. (18 June 2010). PTT. Lab tests online. Retrieved September 29, 2010, from http://www.labtestsonline.org/understandin g/analytes/appt/test.html Pagana, K. D., & Pagana, T. J. (2010). Mosbys manual of diagnostic and laboratory testing. St. Louis, Missouri: Elsevier Inc.