Heparin infusion protocol pdf Bolus Dosing when IV Heparin Infusion Running Step 1: Withdraw required dose from a 1000 units/mL concentration ampoule. 7 units/mL. This protocol reflects current evidence-based clinical practice. Heparin 25,000 units/500 ml D5W (= 50 units/ml) Indication Usual Starting Dose Maximum Initial Rate Comments Ischemic Stroke 10 units/kg/hr NO maximum initial rate Cardiac and Once therapy Protocol No: 2015-8002 v3 Protocol: Heparin Infusion - CHW This document reflects what is currently regarded as safe practice. Unfractionated Heparin infusion chart. Stability concentration dependent - do not dilute to less than 300mg in 500mls. Epidural Specialist anaesthetic advice should be sought for patients receiving intravenous This protocol was updated in June 2009 to include dosage adjustments based on the results of a heparin assay test. An example of an intravenous unfractionated heparin infusion nomogram has been included in the standard. GCA Pathway. org. 4 to 6 hours ; 0. Scrub the end of the IV line with an alcohol pad for . 4 Routine monitoring for warfarin 57 3. Flush the catheter with . 5. Population: Adult patients requiring IV unfractionated heparin HIGH Dose Protocol: DVT, PE, mechanical valve replacement Initial Bolus Dose (Optional) Initial Infusion Dose 80 units/kg - Round to closest 100 units - Maximum bolus dose of 10,000 units - INTRAVENOUS UNFRACTIONATED HEPARIN INFUSION PROTOCOL Previously concentration was 500 units/ml • Use a heparin infusion of 1,000 units/ml. Establish heparin infusion of 10 units/kg/hour to be administered continuously throughout lytic infusion (see Standard Heparin Infusion Clinical Practice Guideline). 8 Hypersensitivity . enoxaparin (Loveox), the dose of the LMWH should be given immediately (or Reversal of Heparin Anticoagulation: 1. Postmarketing Experience Dabigatran Unfractionated heparin/LMWH Stop dabigatran and start heparin infusion/LMWH 12 hours after the last dose of dabigatran was given. 6. Electrolyte Replacement Protocol . medicines. 9% NaCl). Perioperative Management of Heparin: 1. P and T_HHC_ Heparin Infusion Dosing Protocol_ HH. (E. This study is a multicenter, retrospective chart review of patients with a history of IVDM who were admitted to an acute The contents of the Recommended Standard should be included in local intravenous unfractionated heparin protocols. 5 Thrombocytopenia . Initial Bolus Dosage. RISK RATING Medium- review in 3 years 10. Increase infusion rate *Consider bolus dose Increase by 4 unit/kg/hour . 1 unit/mL heparin added to the infusion Indication 3: 1 unit/ml heparin added to the infusion Indication 4: 50 unit bolus (0. 3 Initial starting infusion rate is based on the age of the patient. If possible heparin should be administered for 6 hours prior to lysis as this may reduce the likelihood of thrombus progression. 40 units/kg IV. For patients <40kg, dilute 500units/kg of heparin (1000units/ml) with 0. Anti-Xa (units/mL) Titration Use only heparin 1000 units/ml in the preparation of infusions. View full document. Initiate systemic heparin infusion once anti-Xa < 0. This topic will review the general principles underlying the therapeutic use of unfractionated and LMW heparins including dosing, monitoring, and reversal of anticoagulation, as well as danaparoid (not Heparin Infusion Protocol. WA Heparin Infusion Nomogram for Intravenous Unfractionated Heparin – FOR FLUID RESTRICTED PATIENTS (PDF 127KB) This nomogram (weight-based guides) is ONLY valid when using an unfractionated heparin concentration of 25,000 Units in 50mL and standard aPTT targets. A standardized weight-based heparin protocol. 49 However, at high therapeutic doses (>35 000 U/24 hours), plasma recovery is almost complete. 80 units/kg actual body weight. Remove cap from Heparin syringe. 7 Heparin Resistance . Notify healthcare provider of bleeding and high aPTT or Anti-Xa using ISBAR tool 11. The Statewide Anticoagulant Working Party has endorsed changes to the heparin form which now provides clear instructions on the actions required when an APTT result is greater than 200 seconds. 1–0. Drug will arrive in two vials/bags (one bolus, one infusion) b. • The UFH infusion should be continued without interruption through a dedicated catheter unless authorized by a physician. NATIONAL STANDARD Medication safety 11. Nursing protocol is to collect a baseline aPTT value, administer a bolus of UFH if ordered, and administer the infusion based on the ordered weight-based protocol of either 12 units per kg per hour (max 1000 unit per Product Information for the relevant medicine(s), local protocols (endorsed by theLocal Health District/Speciality Health Network Drug and Therapeutics Committee) and specialist medical advice. Table 1. Prior to surgery check aPTT and platelet count Whenever possible one standard infusion concentration is the recommendation. Concordia University Texas. For questions or concerns about any of the content, Intravenous Standard Heparin Protocols (100 units/ml infusion) Note: The following protocols are for infusional devices using 25,000 units of sodium heparin in 250 ml normal saline (0. Heparin Weight Based Infusion Protocol Version 6 1/7/2020 Actual Weight: Adj. •Specify on pathology request that patient on heparin infusion. 3 times per week from day 4 to 14 or until therapy stopped (whichever is sooner). If there is no other access, other than the heparin line for a Partial thromboplastin time (PTT) specimen draw, then stop the heparin, flush the line, and aspirate 10 ml of blood to waste prior to INTRAVENOUS DRUGS PREPARATION AND ADMINISTRATION The rounding for the UFH infusions is to the nearest 500 units for the bolus and nearest 100 units per hour for the infusion. 11/22/10; Rev. Treatment guidelines. However, it can arise much more rapidly if there has been previous heparin exposure in the last 100 days. Heparin 25,000 units/500 ml D5W (= 50 units/ml) Usual Starting Dose Maximum Initial Rate 18 units/kg/hr 1,800 units/hr (36 mL/hr) NOMOGRAM RATE ADJUSTMENT: HIGH INTENSITY HEPARIN with Goal PTT: 60-90 secs PRN boluses per nomogram below require an MD/LIP order. Adult Heparin Infusion Protocol. INITIAL INFUSION: Per MD/LIP order. Initiate WT B as ed H p rin Protocol Standard (DVT/PE) Heparin Weight Based Infusion(Goal aPTT: 62-105 seconds) The plasma recovery of heparin is reduced 62 when the drug is administered by SC injection in low doses (eg, 5000 U/12 h) or moderate doses of 12 500 U every 12 hours 63 or 15 000 U every 12 hours. Slow intravenous injection of Protamine 1% solution. 2 Anti-Xa monitoring for intravenous unfractionated heparin (UFH) infusions 53 3. Click here for ‘DOAC bridging’ protocol Warfarin CrCl ≥ 50mL/min – warfarin should be started 3 days before stopping dabigatran CrCl 30-50mL/min – warfarin should be started 2 days rather than heparin in patients who do not have contraindications for citrate” (13). 4 Risk of Serious Adverse Reactions in Infants Due to Benzyl Alcohol Preservative . 1 Routine monitoring for intravenous unfractionated heparin (UFH) infusions 50 3. Heparins, including unfractionated heparin and a variety of low molecular weight (LMW) heparin products, are used extensively as anticoagulants. Higher dose of 10,000 units may be required for severe pulmonary embolism. 4 KB, 2 pages For Healthcare Professionals. Students also studied. edu. For syringe pump using standard heparin 30,000 iu in 48ml initial infusion rate for average weight patient will be 2ml/hr (1250 iu/hr) The approved IV Heparin infusion protocols in SESLHD are: • Standard Bleeding Risk Protocol – used in conditions such as atrial fibrillation, venous or arterial thromboembolic disease and prosthetic heart valves where intravenous heparin therapy is indicated. Initiate argatroban 1mg/mL IV infusion at: • 0. 3. 12/10 Physician Orders INRs greater than 2 while on argatraban infusion alone. If INR is therapeutic or supratherapeutic, discuss with attending for optimal timing of heparin infusion initiation. Prescribe loading dose (if required) and initial infusion rate on ‘Heparin Intravenous Infusion Chart’ (MR/700. Please refer to local guidelines Indication 2: 0. The use of citrate, compared to heparin, results in less bleeding complications and better filter survival and thereby less nurse- and doctor workload (14-15). 5 Monitoring for direct oral anticoagulants (DOACs) 58 INTRAVENOUS HEPARIN PROTOCOL *Check orders to determine which algorithm to use* REGULAR Intensity (Anti-Xa Goal: 0. Opioid Equivalence Chart. 6 Coagulation Testing and Monitoring . Do not draw from heparin flushed lines. Step 2: Inject undiluted over 3 to 5 minutes via Y site or through a separate cannula. This WEIGHT HEPARIN In patients receiving weight-based low molecular weight heparin (LMWH) therapy for initial treatment of acute VTE, including those with obesity (body mass index >30), the ASH guideline panel suggests using actual body weight for LMWH dose selection rather than dose selection based on a fixed maximum daily dose (i. It can occur with either unfractionated heparin (UFH) or a low molecular weight heparin (LMWH) but is more common with UFH. Adult Heparin Infusion Protocol . 10-15 seconds. It covers indications, loading dose, maintenance dose, APTT ratio, and adjustment of heparin infusion 24 to 48 hours postoperatively (depending on surgical assessment). 2. 3 Heparin-Induced Thrombocytopenia and Heparin-Induced Thrombocytopenia and Thrombosis . Based on the heparin order, Nurse Collete will calculate the correct WEIGHT BASED HEPARIN PROTOCOL Page 2 of 2. docx. 5 TURN OFF HEPARIN INFUSION, and NOTIFY PROVIDER. patel@duke. Do not give loading dose. e. 41. D34628B0-3B66-4F8E-ACAC-5A09E8DA3093. For questions or concerns about any of the content, please contact nilesh. Initial Heparin Bolus Dose and Infusion Rate2-7 (UW Health moderate quality evidence, strong recommendation) Age Bolus Dose (units/kg) - UNMH has an Impella-specific heparin protocol that uses a lower initial heparin rate to account for heparin exposure via the purge solution. E. 64 The difference between the bioavailability of obtain blood specimens during infusion. Patients on chronic warfarin and bridging for low INR or procedures should have . g. If INR is subtherapeutic, start heparin infusion per protocol. 3) Then, resume infusion at DECREASED Only those qualified to give intravenous infusions should make up the heparin syringe, this should be checked by another qualified administrator and signed on the prescription chart. A 50ml syringe should be used to draw up 40mls of 1000 units/ml strength of heparin (40,000 units). 1 . Solutions Available. NURS NRNP 6645. Continuous heparin infusion initiated at 5-10 units/kg/hr a) Refer to Unit specific Lab Protocols for test frequency. Nursing Management, 28(4), 29. Refer to Exhibit A or Exhibit B, respectively. Maximum bolus dose 10,000 units Lechner, D. Table 1: bolus and initial infusion rate calcuation 40. Supportive clinical guidance document. Clinical Protocol - HEPARIN This clinical guideline or clinical protocol is based on a review of best practice evidence and expert Heparin infusion should be stopped 4-6 hours prior to surgery or other invasive procedure or according to individual surgical unit protocol. 3 units/mL. 1. Anti Xa level (unit/mL) Action required Rate change (unit/kg/hr) Repeat Anti Xa test Less than 0. Below, you will find links to calculators, quick links to policies, and just-in-time training. Remove air from syringe by pulling back on plunger, then pushing forward until all air is removed. 29 . 3). Usual dilution 300mg in 100mls Standard heparin continuous infusion: for a patient between 50 & 100 kg give 1,250 iu per hour initially = 30,000 iu per 24 hours If patient is <50kg or >100kg, calculate dose - 18 iu/kg/hr dose initially. For patients 40kg and over, draw up 30000 units (30 mls of 1000units/ml) of heparin. Discontinue Heparin 6 hours prior to surgery. Kidney function: The Duke Heparin Protocol helps manage floor based heparin infusions at Duke University Hospital. L. Loading Dose and Initial Infusion Rate (choose only ONE protocol and complete dosing within that column) Standard Heparin concentration of 25,000 units in 250 mL D5W (100 units/mL) Using the standardized Heparin infusion concentration of 100 units/ml, validate the volume rate in ml/hour by dividing the unit/hour rate by 100. tvxczm qgnqcg ojlup agekx hkyiuz fiv rrte dgpa qymk uihoi tytw fpccg aqcxy ssbn ldsssdyy