Safety of heparin IV vs SQ

Nurses Safety

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hi,

have a question regarding the safety of heparin iv vs sq.. when a patient is ordered 5000 units SQ, what are the safety issues about giving it IV? I know it shouldn't be given IV, but why? what's the difference between giving a patient heparin SQ as opposed to IV?

thank you much! :)

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Specializes in Burn, CCU, CTICU, Trauma, SICU, MICU.

Its more the DOSE that would be given than the actual thought of giving heparin IV.

5000 units of heparin is A LOT of heparin. giving it subq allows for a slower absorption. giving 5000 units of heparin IV hits the person VERY quickly in a VERY fast way and they would become WAY over anti-coagulated, leading to strokes, death, etc...

IV heparin gtts are will start at 800-900 units per hour and slowly titrate up or down as your drug PTT levels about every 6 hours and closely watch for bleeding complications. 5000 units in one push could be fatal.

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Specializes in cardiothoracic surgery.

5000 units in one push could be fatal.

It could be fatal if it is the wrong dose for the patient. We give boluses prior to starting most of our heparin drips. I once gave a bolus of 10,000 units (after double checking with the MD and pharmacist of course, 10,000 units is a huge bolus) and the patient was fine. The boluses are based on their PTT prior to starting the drip, so if it is calculated correctly and the right dose is given, the patient should be fine. This is what we do at our facility, I am sure other facilities have different protocols.

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Specializes in cardiac, oncology.

SQ heparin is usually given to help prevent blood clots and iv heparin is given when clots are already there (one reason). 5000 unit iv bolus is high, but our protocol is weight based and that is not an uncommon bolus given before the heparin infusion is started. I have given it several times, we are an obese nation, and I have never killed anyone with it.

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Specializes in home health, dialysis, others.

I am curious - - who are you, and why are you asking? This is something that should be addressed with the doc who is ordering the heparin. What is it being given for?

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IV heparin has a half life of only 90 minutes. So even if you do give a large bolus it doesn't stick around long.

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Specializes in Critical Care, Cardiac Cath Lab.
5000 units in one push could be fatal.

5,000 units of unfractionated heparin given IV push is actually a pretty standard dose given to acute MI patients before starting a IIb-IIIa inhibitor (like Integrilin). The standard dose for anticoagulation with unfractionated heparin during PCI is 60 units/kg, so it's not uncommon for me to give 7,000 units of heparin IV push (or more) in the Cath Lab. As others have said, SQ has a slower rate of absorption than IV. The route matters! :p

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Specializes in Critical Care, Cardiac Cath Lab.
IV heparin has a half life of only 90 minutes. So even if you do give a large bolus it doesn't stick around long.

...and it can be reversed with protamine, unlike LMW heparin (i.e. Lovenox). :)

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whats the maximum dose you can given IVP?

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On 5/3/2010 at 8:55 AM, mskate said:

5000 units in one push could be fatal.

In the context the OP is asking, no it couldn't. Not even close. 40,000 units of heparin bolused as fast as you can push it is not at all unusual in cardiac surgery.

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.

Wrong thread.

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Specializes in SICU, Telemetry.

I work in cardiac surgery and we push heparin all the time. So no 5,000 is not a lot unless patient has any issues.

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