bolus heparin i v

oramar · Aug 27, 2000

Originally posted by athenia:
I'm writing for some input on how to administer 2500 units of heparin when a patient is on a heparin drip and their blood work comes back too thick? Do you give it s/c or through the iv at the nearest port to the iv needle in the hand?

You do not say how the MD wrote this order but my guess it said, "2500 unit bolus", this would be given push through the hep lock nearest to the port in the hand. If ever in doubt clarify order, it is better than making med error. The ptt would be repeated in an about a hour.

bunky, BSN, RN · Aug 27, 2000

I agree. I am pretty certain that BOLUS would mean IV, but always ask.

saphie · Aug 27, 2000

It depends where you work... if you are in critical care area, then IV push, if you're in med-surg like myself, where we are not covered to do any sort of IV push, we put it in a minibag and run it in fast, ie. 50 ml bag we'll bolus in 15 mins. So really it depends where you work.. And out of curiousity... I haven't heard where they bolus heparin after a gtt has been initated, what is wrong with the pt?

hollykate · Aug 27, 2000

I agree with the other posters- bolus usually indicates IV. I am as curious as Saphie- why not just up the gtt, rather than another bolus? (So much to learn so little time!) Holly

oramar · Aug 27, 2000

Originally posted by hollykate:
I agree with the other posters- bolus usually indicates IV. I am as curious as Saphie- why not just up the gtt, rather than another bolus? (So much to learn so little time!) Holly

Does anyone have heparin protocols? They are nice, the MD just writes for the protocol and it saves calling them over and over again. My guess is that the MD in this case wrote a additional bolus because the ptt was so low. Unfortunate, it is possible that the ptt was drawn early or that it is inaccurate. The additional bolus will be given and on the next ptt you will get a sky high ptt. The heparin will have to be stopped for a hour then restarted and the MD will be called over and over again and worst of all the patient will have to be stuck for blood again and again. It is better to manipulate the drip than to give a bolus.

beano · Aug 27, 2000

We have a heparin protocol at our hopsital too, but it doesn't mean that you CAN'T call the MD if you notice you're not getting therapeutic PTTs. Like some one else had mentioned, there have been pt's where you give the bolus (always IVP)and increase the gtt rate, check their PTT in 6 hrs, hold the infusion because the PTT is to high and decrease the rate. I've call MD's when I've noticed this had been the trend on a particular pt when a PTT came bak and the protocol called for a bolus and and increase in gtt rate. After getting the order, I would just increase the gtt rate and hold the bolus. Hope this helps.

athenia · Aug 28, 2000

I'd like to thank all of you for taking the time to reply tom my question. We have a set protocol where I work. We keep it at the front of the chart so we never have to call a Dr. again it's already a set order on what to do.(i.e.) If the pt's ptt came back at 41.8 (Canada) we would give the pt a 2500 unit bolus and increase to gtt rate by 4 gtts. Then we would do a follow up ptt in 6 hrs. I really like our system now we don't have to bother doctors in the middle of the night since we started this system. Yes we still give the bolus of heparin while the pt is stillon the i.v. heparin. Ontario, CanadaQUOTE]Originally posted by oramar:

Originally posted by hollykate:
I agree with the other posters- bolus usually indicates IV. I am as curious as Saphie- why not just up the gtt, rather than another bolus? (So much to learn so little time!) Holly

saphie · Aug 28, 2000

Hollykate... I thought it was in terms of initating heparin therapy... plus I think it would be difficult to bolus from the gtt... at our hospital our heparin is 20,000u in 500 D5W... to me it would be easier and also less chance of med error to give it IVP or in a minibag.

Also we do have a heparin protocol, where the doctor decides on the bolus and the inital rate. Then depending on the PTT is how we adjust the rate.

bunky, BSN, RN · Aug 28, 2000

Saphie, you should see the stuff we push here even on a med surg floor! They don't use minibags as extensivley here.

Doey, BSN, RN · Aug 29, 2000

I'm writing in response to the question about the Heparin bolus. I agree that bolus usually does mean IV. Also, at my hospital we have had a heparin protocol in place for a few years now and we follow those guidlines for a specific ptt.(to give a bolus and increase the gtt, or to hold the gtt for 1hr. and restart it at a lower gtt rate etc.) If there are changes made, the next ptt is drawn in 6hrs. After 2 consecutive ptt results requiring no change, the ptt then is drawn daily.