Angiomax is set for a certain rate for bolus and infusion. I started at a new cath lab last week that does their bolus through infusion for this. At what rate would you set your bolus at? 5 min or less? I cant find any info on guidelines because its supposed to be push.
Ask the other cath lab staff what their policy is re: bolus.
You could set the primary infusion rate/volume to be infused, then set a secondary infusion for 999ml/hr X (total ml to be infused -- which is the bolus amount: 16ml or 17.5ml or whatever is appropriate, to the patient's weight).
This will infuse the bolus amount in a rapid amount of time (like a push), then the pump will automatically revert back to the primary rate once the bolus is done.
I'm pretty sure our pump asks for a bolus amount (ml) (or maybe just kgs then if I want the bolus) and then asks over how much time. I put in 60 seconds. Can't do it much quicker than that because it will exceed the rate of 999.
I do it all the time, but am not certain how I do it without it in front of me.
Is it routine for you guys to use Bival at your labs?
Going through school they hammered it into us.. Haven't seen it used since...
What sort of protocol to you use to select appropriate patients for bival vs the run of the mill Heparin strategy? Or is it routine?
Heparin Induced Thrombocytopoenia is an indication of course but the real prevelance of the disorder is .7% - .9% of patients who have recieved heparin in the last 48 hours.
Essentially the most likely scenario would be a longer term inpatient or home care pt with HIT. These vulnerable populations constitute a fraction of cath cases and within that fraction less than 1% will present. So if HIT is the sole criteria I can't imagine you'd give it too often..