Can patients pending angiogram and on heparin (anticoagulant) drip get up and walk around?

Mobilization of Patients on Heparin Drip Awaiting Angiogram

Patients pending angiogram and on heparin drip can safely ambulate and walk around unless they have specific contraindications or are undergoing procedures requiring immobilization. 1

Rationale for Mobilization

The European Society of Cardiology guidelines for management of acute coronary syndromes do not indicate any restriction on mobility for patients on heparin therapy awaiting angiography 1. Similarly, the ACC/AHA guidelines for non-ST-elevation acute coronary syndromes do not restrict mobility for patients on anticoagulation therapy pending angiography 1.

Key points supporting mobilization:

• Early mobilization helps prevent venous thromboembolism (VTE) complications
• Immobility increases risk of complications such as pressure ulcers and deconditioning
• Guidelines recommend DVT prophylaxis for immobile patients, suggesting mobility is preferred when possible 1

Specific Considerations

When Mobilization Is Appropriate:

• Patients on standard heparin drip for ACS awaiting routine angiography
• Hemodynamically stable patients
• Patients with adequate peripheral access for heparin administration
• Patients with no bleeding complications

When Mobilization Should Be Limited:

• Patients scheduled for immediate angiography (within hours) 1
• Patients requiring transseptal or LV puncture during catheterization (heparin should be discontinued 4-6 hours before these procedures) 1
• Patients with hemodynamic instability 1
• Patients with active bleeding or high bleeding risk
• Patients with severe ongoing ischemia requiring bed rest

Practical Implementation

For patients who can be mobilized:

• Ensure IV access is secure with appropriate extension tubing
• Use infusion pumps that can operate on battery power
• Have nursing staff assist with initial ambulation to assess stability
• Monitor for any signs of bleeding at access sites
• Ensure continuous heparin infusion without interruption

Benefits of Mobilization

1. Reduced risk of VTE complications - early mobilization is a key component of VTE prophylaxis 1
2. Decreased risk of hospital-acquired complications (pressure ulcers, pneumonia)
3. Maintained muscle strength and cardiovascular conditioning
4. Improved patient comfort and psychological well-being

Clinical Pitfalls to Avoid

• Do not mobilize patients with unstable vital signs or active chest pain
• Avoid disconnecting heparin infusion during ambulation as this can lead to subtherapeutic anticoagulation
• Be cautious with femoral access sites - these require more careful monitoring during mobilization than radial access sites 2
• Do not assume immobility is required simply because a patient is on anticoagulation therapy

In summary, the practice of keeping patients immobile while on heparin drip awaiting angiography is not supported by current guidelines. Unless specific contraindications exist, early and appropriate mobilization should be encouraged to prevent complications associated with prolonged bed rest.