Heparin IV administration

[starcandy]

At my facility, there is a policy of hanging a primary bag of 0.9 NS @ KVO with the heparin infusion. I cannot get a logical reason for this practice and have been told that slow infusions + NS will decrease the incidence of clotting??? I think that the NS line should be eliminated because I have noticed the increased incidence of errors such as using the line for IVPB or the heparin is plugged in a port farthest away from the patient. Another point is the heparin is already diluted with D5W wouldn' t this practice further dilute the strength once it is mixed with NS?

[augigi, CNS]

Never heard of a need for this, or of any unit doing it that way. Can't see a reason to either. Heparin infusions aint going to clot!!

[SharonH, RN]

I cannot get a logical reason for this practice and have been told that slow infusions + NS will decrease the incidence of clotting???

What???? If that's really the reason, wouldn't it be cheaper and less labor intensive to simply flush the line with 1cc NS qshift to leep the line patent? To waste an entire bag of NS + tubing etc just to prevent the line from clotting is just silly.

I've never heard of this practice but there must be something more to it. It just seems silly to me, I've never had a line with Heparin infusing clot off, it IS Heparin after all but I'm sure there is going to be a bevy of people tell me that it happened to them but....

[Moneypitt]

Our policy is to run the Heparin as a primary line. Not trying to be condescending but have you actually seen the policy in writing, or have been told by other nurses that this is the procedure? Even the drug reference books that I use recommend heparin to be run seperate from any other fluid, so any other policy sounds very odd to me.

[Mulan]

I don't know if this is the case, but years ago a mainline was hung (with certain meds) in case you had to shut the med off in a hurry, you just stopped the med and ran the mainline, it was a matter of safety. Also, years ago many places didn't have the extension, saline lock type connection, that they use today with just about every IV start which would have made it more difficult to stop one infusion and start another.

Maybe you could check with your nurse educator or whoever is responsible for updating the policy/proceedures and see what reason they have for it.

[Burnt Out, ASN, RN]

It is our policy to have NS or 1/2 NS as a mainline then we connect our heparin to the port nearest the patient-we do it for safety.

[fins]

I don't know if this is your facility's reason, but this is why I always run heparin piggy-backed into a maintenance fluid.

I had an IV infiltrate once when it had only heparin infusing into it. The problem is, when you're infusing heparin at 900 Units/hr, that's only 9ml/hr. The fact that it's infiltrated doesn't become apparent for quite some time. Meanwhile, the patient's ptt became non-theraputic, and we couldn't figure out why. If I have the heparin going into a maintenance fluid, I know that it's going into the vein.

[jojotoo, RN]

I don't know if this is your facility's reason, but this is why I always run heparin piggy-backed into a maintenance fluid.

I had an IV infiltrate once when it had only heparin infusing into it. The problem is, when you're infusing heparin at 900 Units/hr, that's only 9ml/hr. The fact that it's infiltrated doesn't become apparent for quite some time. Meanwhile, the patient's ptt became non-theraputic, and we couldn't figure out why. If I have the heparin going into a maintenance fluid, I know that it's going into the vein.

THIS is the first reasonable/ logical explanation that I have ever heard.:yelclap:

[starcandy]

I don't know if this is your facility's reason, but this is why I always run heparin piggy-backed into a maintenance fluid.

I had an IV infiltrate once when it had only heparin infusing into it. The problem is, when you're infusing heparin at 900 Units/hr, that's only 9ml/hr. The fact that it's infiltrated doesn't become apparent for quite some time. Meanwhile, the patient's ptt became non-theraputic, and we couldn't figure out why. If I have the heparin going into a maintenance fluid, I know that it's going into the vein.

I have not seen a policy in writing that is why I asking others experiences. I haven't received a good explanation for the NS primary line. This is a best explanation so far I've heard. But wouldn't the heparin concentration(25000u/250ml) be further diluted with the NS,taking a longer time to become therapeutic?? I have been running the heparin alone and during report the following nurse always adds the NS due to "policy" that I cannot locate and have asked pharmacy who didn't even know the answer. I think that heparin should run alone and get a second IV for other meds/fluids to decrease errors and the temptation of adding other meds to maintenance fluid.

[jojotoo, RN]

I have not seen a policy in writing that is why I asking others experiences. I haven't received a good explanation for the NS primary line. This is a best explanation so far I've heard. But wouldn't the heparin concentration(25000u/250ml) be further diluted with the NS,taking a longer time to become therapeutic?? I have been running the heparin alone and during report the following nurse always adds the NS due to "policy" that I cannot locate and have asked pharmacy who didn't even know the answer. I think that heparin should run alone and get a second IV for other meds/fluids to decrease errors and the temptation of adding other meds to maintenance fluid.

I doesn't matter that the heparin is further diluted, the patient will still get the same ordered mg of drug/min. It's the same as if you gave Morphin 1mg/1ml IVP, or if you diluted that 1mg/1ml with 10ml NS and gave it IVP - you are still giving 1mg of Morphine.

[zacarias, ASN, RN]

If a pt's heparin gtt is running at 35cc/hr, then you should be fine with heparin as the only line since that rate will keep the vein open.

If you a have little frail pt who only gets 9cc/hr of heparin. Your chancing it if you don't have saline running at a TKO rate. Do you really want to chance it with heparin?

Also, you should consider the risk of fluid overload in certain patients and not indiscriminately hang "excess" fluids.

[Celia M, ASN, RN]

We have a NS TKO order with IV heparin as a secondary so if there is an emergency we have something that can be run quickly, to prevent and accidental heparin bolus. If there is a mainline IV running them the NS TKO is not needed.