Heparin bolus administration

dudette10, MSN, RN · Jun 10, 2014

This is someone on a heparin drip, right? I too give the bolus right from the pump; the pumps we use have a bolus mode. Actually the vials of heparin that we do use for sub q say on them "Not for IV administration."

If you are talking about the 5000 u per ml single dose vials that are orange, the vial says it can be IV or SQ, but in big letters it says, "not for hep lock." Hep locks should be the 10 units per ml concentration, usually in pre filled syringes that are blue. The 100 u per ml are yellow, which can be used to de-access a port.

RNlove17 · Jun 17, 2014

I give boluses IVP usually, as do most nurses on my unit. I'm on a rehab unit though and we do not commonly have pt's already on heparin drips though and don't even usually have piggybacks, just a primary. A bolus means through an IV... how is she getting subq from that??

arosejr · Oct 4, 2017

I am interested in what medications you are blousing from the infusion bag, ie. insulin, heparin, Cardizem. thanks in advance.

offlabel · Oct 4, 2017

An IV bolus of heparin has a very different onset and action than a SQ injection.

nrsdrw · Mar 26, 2018

Your preceptor needs an inservice.

RNMatt87 · May 31, 2018

draw up 4ml and give via IV. SQ is not considered a bolus dose. at least not where i come from. as a vascular lab circulator that's one drug i give 99.9% of cases i do. your preceptor needs a preceptor. also i never bolus from the bag unless i'm bolusing IV fluid.

marable · Oct 8, 2018

Never heard of giving a heparin bolus sq....The policy where I worked was to give the heparin bolus iv push and then follow protocol as to when to draw ptt labs and change heparin drip rates ....

mtmkjr, BSN · Oct 8, 2018

I know this is old and the OP has moved on from this topic most likely!

But I just wanted to add that I'd be concerned that the preceptor isn't abiding by the rights of med. administration, one of which is "right route". From the info given, nowhere does the order say heparin bolus "SQ". So lacking the specific instruction to be given that way the boluses would be IV as it is paired with the drip order.

Just a few moments thinking this through should have become clear, and if not, there should have been verification from the ordering provider or a call to pharmacy.

jaderook01, BSN, RN · Oct 16, 2018

When giving a Heparin bolus, and the vial is 10,000 units/10mL (1000units/mL concentration), and the bolus is to be for 4000units, would you not draw 4mL into a syringe and give it IVP? (This is the bolus that precedes an infusion with a bag that is of a 100unit/mL concentration.)
My preceptor told me that I was supposed to use a tuberculin/Heparin syringe and draw up 4 "units" and inject it subQ for the bolus.
???

Where I work, a heparin bolus is always IV and not subQ. The order will even state it clearly.

RDH-RN · Nov 8, 2020

On 10/8/2018 at 9:18 AM, mtmkjr said:

I know this is old and the OP has moved on from this topic most likely!

But I just wanted to add that I'd be concerned that the preceptor isn't abiding by the rights of med. administration, one of which is "right route". From the info given, nowhere does the order say heparin bolus "SQ". So lacking the specific instruction to be given that way the boluses would be IV as it is paired with the drip order.

Just a few moments thinking this through should have become clear, and if not, there should have been verification from the ordering provider or a call to pharmacy.

This is old, but I've just gotten back on here.

It was clear. That was kind of my point. But, I was a brand new nurse with a bully for a preceptor who no one wanted to go up against. There were 3 other nurses in the nurses station that listened to that conversation; none of them intercede. Nine of them corrected her. None of them pulled me aside to tell me she was wrong, or explain the proper way to do it. It was also on night shift, and I wasn't about to call a physician in the middle of the night, as a new nurse, and tell him what ridiculous BS my preceptor was telling me to do. She repeatedly set me up for failure. And while something "should" have been clear and all the other "should haves" you mentioned, consider where I, the OP, was coming from and the position I was in. If I felt it was okay (I.e., SAFE), to question what she was telling me, I wouldn't have posted here and come here to ask for advice.

MurseCC · Jun 19, 2024

This is an interesting thread. I would like to have a copy of anyone's policy/procedure/protocol regarding Heparin Administration for STEMI if anyone is willing to share. An exhaustive search has led me here...thanks in advance.