Ivy bleeding time


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Ivy bleeding time

Hematology A quantitative coagulation assay based on a standardized skin wound, which measures platelet and vascular responses to injury; ↑ in Bernard-Soulier disease, Glanzmann's thrombasthenia, platelet defects–eg, thrombocytopenia, storage pool disease, vascular defects–eg, Ehlers-Danlos disease, von Willebrand's disease

Bleeding Time

Synonym/acronym: Mielke bleeding time, Simplate bleeding time, template bleeding time, Surgicutt bleeding time, Ivy bleeding time.

Common use

To evaluate platelet function.

Specimen

Whole blood.

Normal findings

(Method: Timed observation of incision)

Template: 2.5 to 10 min

Ivy: 2 to 7 min

Slight differences exist in the disposable devices used to make the incision. Although the Mielke or template bleeding time is believed to offer greater standardization to a fairly subjective procedure, both methods are thought to be of equal sensitivity and reproducibility.

Description

There are three main stages of hemostasis. Primary hemostasis includes constriction of injured blood vessels, exposure of subendothelial collagen, platelet aggregation and adhesion, and formation of a plug. Secondary hemostasis involves the coagulation cascade with subsequent formation of a fibrin clot. The third stage of hemostasis is clot retraction and healing. Bleeding time assesses platelet and capillary function.

This procedure is contraindicated for

    :N/A

Indications

  • Many laboratories have discontinued the use of bleeding time testing in favor of prothrombin time (PT), activated partial thromboplastin time (aPTT), platelet count, and platelet function testing as appropriate. This change in laboratory practice is based on the results of studies that do not support the clinical value of bleeding time in either surgical or nonsurgical applications.

Potential diagnosis

This test does not predict excessive bleeding during a surgical procedure.

Prolonged In

Bernard-Soulier syndrome (evidenced by a rare hereditary condition in which platelet glycoprotein GP1b is deficient and platelet aggregation is decreased) Fibrinogen disorders (related to the role of fibrinogen to help platelets link together) Glanzmann’s thrombasthenia (evidenced by a rare hereditary condition in which platelet glycoprotein IIb/IIIa is deficient and platelet aggregation is decreased) Hereditary telangiectasia (evidenced by fragile blood vessels that do not permit adequate constriction to stop bleeding) Liver disease (related to decreased production of coagulation proteins that affect bleeding time) Some myeloproliferative disorders (evidenced by disorders of decreased platelet production) Renal disease (related to abnormal platelet function) Thrombocytopenia (evidenced by insufficient platelets to stop bleeding) von Willebrand’s disease (evidenced by deficiency of von Willebrand factor, necessary for normal platelet adhesion)

Decreased in

    N/A

Critical findings

  • Greater than 14 min

  • Note and immediately report to the health-care provider (HCP) any critically increased values and related symptoms.

  • It is essential that critical findings be communicated immediately to the requesting HCP. A listing of these findings varies among facilities.

  • Timely notification of a critical finding for lab or diagnostic studies is a role expectation of the professional nurse. The notification processes will vary among facilities. Upon receipt of the critical finding the information should be read back to the caller to verify accuracy. Most policies require immediate notification of the primary HCP, hospitalist, or on-call HCP. Reported information includes the patient’s name, unique identifiers, critical finding, name of the person giving the report, and name of the person receiving the report. Documentation of notification should be made in the medical record with the name of the HCP notified, time and date of notification, and any orders received. Any delay in a timely report of a critical finding may require completion of a notification form with review by Risk Management.

  • Potential nursing interventions for bleeding include applying pressure to the incision until the bleeding stops and covering the incision site with a bandage. Some people are more prone than others to develop scars or keloids. Generally, they are pink to reddish in color, raised, and shinier than the surrounding skin. They can be itchy, tender, or even painful to the touch. There is no immediate intervention to prevent the formation of scars or keloids. Treatment options for developed scars and keloids range from cortisone injections to a variety of strategies for removal, each of which can vary widely in degree of success. The site should be observed for subsequent bleeding, bruising, or redness. Fever, localized redness, or warmth of the area to the touch may be indications of infection. Potential nursing interventions include monitoring temperature as well as administering antipyretic and antibiotic medications, as ordered.

Interfering factors

  • Drugs and substances that may prolong bleeding time include acetylsalicylic acid, aminocaproic acid, ampicillin, asparaginase, aspirin, canola oil, carbenicillin, cilostazol, clopidogrel, dextran, diltiazem, flurbiprofen, fluroxene, ketorolac, moxalactam, nafcillin, naproxen, nifedipine, NSAIDs, penicillin, piroxicam, plicamycin, propranolol, streptokinase, sulindac, ticarcillin, ticlopidine, tolmetin, valproic acid, and warfarin.
  • Aspirin or related products should not be taken for at least 1 wk prior to the test.
  • Drugs that may decrease bleeding time include desmopressin and erythropoietin.
  • high alertThe test should not be performed on patients who must be restrained, have excessively cold or edematous arms, have a platelet count less than 50 × 103/microL, have an infectious skin disease, or cannot have a blood pressure cuff placed on the arm.

Nursing Implications and Procedure

Pretest

  • Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
  • Patient Teaching:  Inform the patient this test can assist in evaluating the amount of time it takes for blood to clot.
  • Obtain a history of the patient’s complaints, including a list of known allergens, especially allergies or sensitivities to latex.
  • Obtain a history of the patient’s hematopoietic system, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.
  • Obtain a list of the patient’s current medications including anticoagulants, aspirin and other salicylates, herbs, nutritional supplements, and neutraceuticals (see Effects of Natural Products on Laboratory Values). Note the last time and dose of medication taken.
  • Review the procedure with the patient. Inform the patient that specimen collection takes approximately 2 to 15 min. Address concerns about pain and explain that there may be some discomfort during the procedure. Inform the patient that scarring, keloid formation, or infection may occur.
  • Sensitivity to social and cultural issues,  as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
  • Note that there are no food or fluid restrictions unless by medical direction. Instruct the patient to withhold aspirin or related products for at least one week prior to testing, as ordered.

Intratest

  • Potential complications: N/A
  • Ensure the patient has withheld aspirin or related products for at least 1 wk prior to testing.
  • Instruct the patient to cooperate fully and to follow directions. Direct the patient to breathe normally and to avoid unnecessary movement.
  • Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient. Place a blood pressure cuff on the arm above the elbow and inflate to 40 mm Hg. Cleanse the site with alcohol and wait until it is air-dry. Hold skin taut. Avoid superficial veins and use bleeding time device to make a parallel incision about 3 mm deep into the muscular outside area of the forearm distal to the antecubital fossa (in the direction of wrist to elbow). Start stopwatch immediately. At 30-sec intervals, blot the incision site, in a clockwise fashion, on the edge of a piece of filter paper. The test concludes when the bleeding stops or if bleeding continues longer than 15 min. Bleeding time is determined by adding the total number of blots on the filter paper (30 sec or 0.5 min).
  • Observe/assess the incision site for bleeding. It may be necessary to place a dressing or butterfly bandage on the site after the test.

Post-Test

  • Inform the patient that a report of the results will be made available to the requesting HCP, who will discuss the results with the patient.
  • Inform the patient with a bleeding disorder of the importance of taking precautions against bruising and bleeding. These precautions may include the use of soft-bristle toothbrush, use of an electric razor, avoidance of constipation, avoidance of acetylsalicylic acid and similar products, and avoidance of intramuscular injections.
  • Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Answer any questions or address any concerns voiced by the patient or family.
  • Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.

Related Monographs

  • Related tests include clot retraction, coagulation factors, CBC platelet count, PT/INR.
  • Refer to the Hematopoietic System table at the back of the book for related tests by body system.