heparin protocol

[rookreck]

At my institution we have weight based heparin protocal orders. We have a lot of trouble getting a therapeutic ptt. The patient gets stuck every 6 hours until we get 2 therapeutic Ptt's in a row. Then the Ptt goes to daily. It just seems like the patient gets stuck a whole lot more with protocols. Does anyone else have problems with this?

[pricklypear]

We only need 1 therapeutic level before we go to daily. That's how it was at my last job as well. Do you find that you often don't get a therapeutic level the second time? If you are consistently getting 2 in a row, then perhaps the protocol needs to be revised?

[rookreck]

We give a bolus with the initial start of heparin. So 99% of the time the first ptt is greater than 110. We then hold the heparin for 1 hour and decrease by so many units and repeat in 6 hours. It just seems like the patient is the one that suffers, by getting so many sticks.

[hrtprncss]

Wow 99 percent above 110? If I can ask, how much initial bolus do you guys give?

EDIT: Just wanted to add that we now use Anti Factor Xa as oppose to PTT for heparin gtt.

[rookreck]

It is all weight based. I don't know the exact amounts.

[zambezi, BSN, RN]

We also start with a weight based heparin bolus (I want to say 50 units/kg, but I can't remember so I could definately be wrong). Then we run the actual drip at 15 units/kg/hr. We do a PTT in 6 hours. Everything time we make a change we have to draw another PTT (Q6hr) Once we reach therapeutic range, then we just check the PTT daily. It does seem like a of pokes for the patient, but it is for their safety...

[hrtprncss]

What I've usually seen is either a fixed 5000 unit bolus or 80units/kg initial bolus but of course I maybe wrong, I should ask the in house pharmacist.