My facility uses a weight based heparinprotocol. Recently, I had a (new to me) experience that left mequestioning myself and my RNM.
My patient had been off the drip for a few hours for imagining studies. Whenthe patient came back, the aptt was in the 50's. Per the procedure, I wasaccompanied by a second nurse to witness the increase in dose and bolusper protocol.
The thing that threw me for a loop was the bolus dose. The patient isobese, greater than 225kg. The bolus order is 80 units/kg. I have nevergiven a heparin bolus of such magnitude (>18000 units). The witnessingnurse verified the order, the math, and the set up. She then said that she hadnever given such a large dose either.
I went to the RNM who rechecked the order, my math, and the set up. Shetold me not to chart anything yet (whaaaa???) and walked away. Asshe did not return within 30 minutes, I charted exactly what I had done,including a comment with the calculation.
Shortly before the end of the shift, she told me to go ahead and chart thebolus.
It came as no surprise to me that the patient's aptt came back criticallyhigh. Fortunately, I was handing off to a seasoned nurse that I have alot of confidence in.
I know that I followed the protocol as written. But, is this a normal bolusdose for an obese patient? Do other facilities have a separate protocolfor patients with a very high bmi?
Thanks in advance for your time.