Beruflich Dokumente
Kultur Dokumente
Coordination: Lee Vermeulen, RPh, MS, FCCP Director, Center for Drug Policy
A. The prescriber will initiate the heparin protocol by writing an order to begin heparin per protocol.
The order must specify the intended dosing regimen and if an initial bolus is desired.
B. Once the prescriber orders the heparin protocol, the nurse takes the following steps:
1.0 Review initial order for desired dosing regimen (low, medium, high intensity) and whether a bolus
is indicated.
Maximum Initial
Bolus Dose Maximum Bolus Initial Infusion
Regimen Infusion Rate
(units/kg) (units) (units/kg/hr)
(units/hr)
Low 60 4000 12 1000
Medium 70 7000 15 1400
High 80 10,000 18 2000
2.0 Obtain actual body weight. Use best estimate of true weight if unable to weigh patient. Record
weight in HealthLink. Make calculations using actual body weight.
Page 1 of 3
5.0 Prepare and administer the initial heparin bolus, if one is ordered. If no bolus is ordered, proceed
to step 6.
5.1 Document bolus in HealthLink
5.2 Use heparin 1000 units/mL vial for bolus from floor stock.
Low and Medium Intensity (Arterial Thrombosis) Heparin Anticoagulation Dose Adjustments
aPTT (seconds) Bolus/Hold Infusion
<34 Give supplemental bolus if ordered & inform 100 units/hr = 2 mL/hr
MD
34-37 Give supplemental bolus if ordered & 100 units/hr = 2 mL/hr
inform MD
38-44 0 50 units/hr = 1 mL/hr
45-54 0 NO CHANGE
55-64 0 50 units/hr = 1 mL/hr
65-84 0 100 units/hr = 2 mL/hr
85-100 Hold infusion 1 hour & inform MD 150 units/hr = 3 mL/hr
101-125 Hold infusion 1 hour & inform MD 200 units/hr = 4 mL/hr
>125 Hold infusion 1 hour & inform MD 200 units/hr = 4 mL/hr
If two consecutive aPTTs are greater than 125 seconds, patient should not be maintained on the heparin
protocol. Recommend consultation with Pharmacy and/or Hematology for assistance with dosing.
Page 2 of 3
9.0 Monitoring
9.1 Every eight hours: Inspect line/surgical/wound sites for bleeding and check patient for
symptoms indicating bleeding such as hematomas, bruising, and respiratory symptoms.
Contact MD for any signs of bleeding.
9.2 Provider should be notified if:
9.2.1 Baseline aPTT > 34 seconds or baseline INR > 1.2
9.2.2 Hemoglobin decreases by > 2 g/dL from baseline or platelets <100,000/microliter
or platelets decrease by greater than 1/3 of baseline value
9.2.3 aPTT is less than 38 seconds or greater than 84 seconds if patient is on low or
medium intensity regimen
9.2.4 aPTT is less than 45 seconds or greater than 85 seconds if patient is on high
intensity regimen
9.2.5 Patient has any deterioration in neurologic status
Reference:
Antithrombotic and thrombolytic therapy: American College of Chest Physicians Evidence-Based Clinical
th
Practice Guidelines (8 Edition). Chest. 2008;133(6 Suppl):67S-887S.
Page 3 of 3