Heparin drip calculation problems registered nurse rn. Begin therapy with warfarin at a dose of 5 mg or less per day with dosage adjustments based on serial inr determinations. Guidance for the practical management of the heparin. Your patient is currently receiving an infusion based on 18unitskghour. This recommended standard is based on premix infusion bag of heparin 25,000 units in 250 ml normal saline 100 units per ml. Start the infusion at 2mlshour 1,000 unitshour check aptt ratioaptt sec 4 hours after infusion start. Dose adjustments to both the bolus dose and the initial infusion dose may be. Patients age 18 years or older receiving heparin therapy for greater than or equal to 24 hours identified.
Adult unfractionated heparin infusion protocol objective. Obtain ptt 6 hours after initiation of heparin and after any subsequent changes until therapeutic x 2, then every am. Efficacy of rd heparin a lmwh and warfarin for prevention of. Weightbased argatroban dosing nomogram for treatment of heparininduced thrombocytopenia article pdf available in annals of pharmacotherapy 431.
Jan 16, 2016 when a weight based heparin dosing strategy is selected, we suggest total body weight for calculating dose and encourage internal audits of protocol performance. I did not address them, but definitely should have. Heparin therapeutic unfractionated heparin ufh infusion. Listed anticoagulant conversion to heparin infusion warfarin if no hepatic insufficiency, start argatroban. Intravenous unfractionated heparin higherbleeding risk protocol 2 commercially prepared premixed heparin solutions risk medicines management policy pd2015029. At our institution a weight based heparin nomogram was in place, however an initial data analysis revealed a large percent of the initial aptt levels were above therapeutic range. Plt protocol heparin iv weight based protocol, constant indicator heparin protocol record prn order nursing.
Heparin infusion guidelines anticoagulation services. Therapeutic dosing of unfractionated heparin adult. Effective titration of iv heparin typically requires administration of an initial loading bolus, a titrated weight based drip rate, and repeat bolus doses. Guidance for the practical management of the heparin ncbi. In 1996, a weightbased protocol for administration of heparin was implemented and assessed at the authors institution.
College lab week 1 objectives unit i perfusionrelated to alterations in perfusion weekly course objectives. The titrated drip rate for iv heparin and subsequent bolus doses are based on the lab results from the antixa or aptt test. Do not start in patients who have had tpa, for ischemic stroke, within 24 hours. Discontinue all other orders for heparin products i. Unfractionated heparin infusion protocol hospital quality institute. In 1997, providence hospital in washington, dc, chartered an interdisciplinary team to design and implement an institutionspecific weight based heparin protocol. Redesign of a weightbased heparin protocol for improved. In 1997, providence hospital in washington, dc, chartered an interdisciplinary team to design and implement an institutionspecific weightbased heparin protocol. Heparin infusion guidelines university medical center. For the obesemorbidly obese patient either total body weight or adjusted body weight can be used.
Adult heparin drip protocol ventura county, california. Heparin drip practice calculation problems for nurses. Evaluation of 2 weightbased protocols for administration of. To standardize heparin anticoagulation therapy at university hospital. Venous thromboembolism prophylaxis adult inpatient. The authors 2017 implementation of a weightbased, nurse. Rx ultra low heparin infusion protocol nurse adjusts heparin dose using a standardized algorithm to maintain antixa between 0. Heparin 5000 units sq every 8 to 12 hours class i, level b extreme obesity patients bmi 40 kgm2 enoxaparin 40 mg sq every 12 hours class iia, level b low body weight patients weight 50 kg enoxaparin 30 mg sq every 24 hours class iib, level c or heparin 5000 units sq every 8 to 12 hours class i, level b 3.
Exemplars used this week are htn, cad, and acute mi 1. These heparin practice problems were designed to help you better understand how to titrate a heparin drip based on aptt. If you are offcampus, you must use vpn software to view these guidelines. Therapeutic dosing of unfractionated heparin adult emergency departmentinpatient clinical practice guideline.
The current heparin infusion protocols prescribing patterns, medication. The cec recommends use of premix infusion bags for. In nursing school, you will be required to learn how to solve these types of problems, along with other drug and dosage. Despite the limitations, after changing the iv heparin protocol to weightbased dosing, there are numerical improvements in total hours in therapeutic aptt while on the heparin drip and time to first therapeutic aptt. The effectiveness of an existing nonweightbased heparin nomogram in achieving a therapeutic aptt was compared sequentially with that of a weightbased heparin nomogram in 89 and 84 consecutive. When a weight based heparin dosing strategy is selected, we suggest total body weight for calculating dose and encourage internal audits of protocol performance. Overlap warfarin with heparin for at least 5 days and until the inr is within the therapeutic range for 2 consecutive days. Verify a clinical dosing weight has been documented in kilograms. Order standard heparin infusion with starting rate defaulted based on indication. If your values are above the recommendedmaximum values, then that the maximum value is what you would. Since then, several modifications have been made, including introduction of a lowertarget protocol. Achievement of anticoagulation by using a weight based heparin dosing protocol for obese and nonobese patients. Interest in implementing a weightbased protocol at the community.
Baseline labs ptinr aptt cbc monitoring while on heparin antixa level 6 hours after starting the infusion and 6 hours after each change in the infusion rate. Clinical trials have demonstrated the ability of weightadjusted nomograms to achieve a therapeutic activated partial. Therapeutic dosing of unfractionated heparin uw health. Timings of heparin institution, heparin dose adjusted for body weight aptt and body temperature were noted at baseline, twice during hypothermia, during.
What drives me craziest is the differing concentrations of heparin. Overlap warfarin with heparin for at least 5 days and until the inr is within the therapeutic range for 2. Intravenous unfractionated heparin standard risk protocol, or intravenous unfractionated heparin higher. It is not a substitute for appropriate clinical evaluation and does not supersede clinical judgment. Do not administer heparin if tpa given within 24 hr heparin infusion. Intravenous iv ufh has an immediate onset of action but requires monitoring and infusion rate adjustments in order to achieve a targeted therapeutic range5.
The optimal initial dosing of continuous infusion heparin therapy is controversial. For acute thrombosis a higher weight based bolus may be required. Every where i go its something differentcruikshank, weight based, some personal kind, just anything. These practice problems for heparin drip calculations will test your ability to calculate. Access heparin drip initial bolus and infusion rate. Discontinue heparin if platelets decrease by 50% from baseline and proceed with hit protocol. Heparin iv drip weight based vte adult protocol subphase vital signsmonitoring confirm dosing weight is documented and accuratenote notify provider laboratory results prior to initiation of protocol, call if.
Learn how to solve heparin drip calculations nursing. If your values are above the recommendedmaximum values. Identify factors andor comorbidities affecting andor contributing to perfusion. All hospitalized patients should be evaluated for both bleeding and vte risk within 24 hours of admission, upon transferring level of care, and periodically during the. Despite the limitations, after changing the iv heparin protocol to weight based dosing, there are numerical improvements in total hours in therapeutic aptt while on the heparin drip and time to first therapeutic aptt. You will be required to solve problems that require you under unitkghr, unithr, and mlhr. Heparin iv drip weightbased vte adult protocol subphase vital signsmonitoring confirm dosing weight is documented and accuratenote notify provider laboratory results prior to initiation of protocol, call if. The effectiveness of an existing non weight based heparin nomogram in achieving a therapeutic aptt was compared sequentially with that of a weight based heparin nomogram in 89 and 84 consecutive. Adult heparin infusion protocol this protocol reflects current evidence based clinical practice. It has been recognized in the literature that patients in whom heparin infusion therapy is dosed according to weightbased nomograms achieve earlier therapeutic range, shorter length of. Interest in implementing a weight based protocol at the community. Dosage calculation using a heparin protocol youtube. However, the dosing of heparin to reach a therapeutic level has been controversial.
Only approximately one third of an administered dose of heparin binds to at, and this fraction is responsible for most of its anticoagulant effect. If there is hepatic insufficiency, start parenteral a to heparin infusion 1. Total body weight tbw as dry weight will be used to calculate doses 1 c. Adult heparin infusion protocol this protocol reflects current evidencebased clinical practice. It has been recognized in the literature that patients in whom heparin infusion therapy is dosed according to weightbased nomograms achieve earlier therapeutic range, shorter length. Evaluation of current heparin weight based protocol in obese.
Order as needed rebolus for subtherapeutic antixa, if warranted. The lower end of the dosing range is used for patients with dvt deep vein thrombosis. The standard concentration for heparin is 25,000 units250 ml d5w heparin doses should be rounded to the nearest 100 unitshr increment monitoring. Unfractionated heparin infusion protocol objective. An asneeded aptt order for laboratory draws is built into the ufh order set for patients ordered for the nomogram, allowing the nurse to obtain an appropriately timed aptt per protocol based on the time of the last. Dec 22, 2014 how to make swiss roll cake basic roll cake recipe easy roll cake duration. Evaluation of current heparin weight based protocol in. It has been recognized in the literature that patients in whom heparin infusion therapy is dosed according to weight based nomograms achieve earlier therapeutic range, shorter length. Heparin assay 6 hours after each dosage change, until 2 consecutive therapeutic levels are reached at a constant rate of infusion, then can. If inr is subtherapeutic, start heparin infusion per protocol.
Total units in iv bag unitshour total volume ml x mlhour your patient has a dvt is ordered for a heparin infusion to start at 18 unitskghour per the practitioners order. Heparin overview1 heparin is a glycosaminoglycan which inhibits the mechanism that induces the clotting of blood and the formation of stable fibrin. Unfractionated heparin ufh is used intravenously when therapeutic anticoagulation is warranted and low molecular weight heparin is not a suitable option. Pharmacy will be able to order antixa levels and adjust enoxaparin dosing based on levels per protocol. Every where i go its something differentcruikshank, weightbased, some personal kind, just anything. It has been recognized in the literature that patients in whom heparin infusion therapy is dosed according to weightbased nomograms achieve. Pharmacy will be able to adjust enoxaparin based on renal function. For patients on heparin unfractionated or low molecular weight.
Therapeutic dosing of unfractionated heparin adult emergency. Overall this change in the iv heparin protocol suggests a trend towards. Because the anticoagulant effect of warfarin is delayed, heparin is administered for rapid anticoagulation. If inr is therapeutic or supratherapeutic, discuss with attending for. Evaluation of 2 weightbased protocols for administration. The following guideline provides recommendations for. The following anticoagulation drug guidelines are only accessible to johns hopkins faculty and staff who are accessing this site from within the johns hopkins network. Timings of heparin institution, heparin dose adjusted for body weight aptt and body temperature were noted at baseline, twice during hypothermia, during rewarming phase and during stable condition. These changes warranted reevaluation of the standard and lowertarget protocols. Adult heparin drip protocol this protocol reflects current evidence based clinical practice. Identify commonly used treatments, identified by standards of care, for patients. Lowmolecularweight heparin enoxaparin vs dextran 70. Venous thromboembolism prophylaxis adult inpatientambulatory.
Be sure to not exceed max doses in obese patients iii. Iv heparin safety initiative standardizes protocols. A weightbased heparin protocol for improved anticoagulation. Heparin iv infusion protocol and orderset approved changes. Demographics and other clinical data ere collected. Heparin iv drip weightbased vte adult protocol subphase. Heparin drip calculation reference sample calculations for reference only. It has been recognized in the literature that patients in whom heparin infusion therapy is dosed according to weight based nomograms achieve earlier therapeutic range, shorter length of stay, and fewer. Achievement of anticoagulation by using a weightbased heparin dosing protocol for obese and nonobese patients.
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