heparin bolus and continous infusion

[mspurple]

this pt. who had a chest pain and lab results shows a high troponin t level. a heparin 3.83 ml bolus was ordered then after 765 units/hr continous infusion. my question, is it okay to start the continous infusion right away after the bolus? :-) and which one will be the basis for aptt check after 6 hours, the bolus or ccintinous infusion? thanks guys

[Aurora77]

Is this homework? What's the difference between the bolus and the continuous infusion? What does the PTT show? Why would it be necessary to know the PTT level after beginning a heparin infusion?

[mspurple]

if im not mistaken bolus is considered to be the loading dose of heparin when starting a heparin therapy. it is titrated until the desired ptt is achieved. ptt is the time needed for a blood to clot. that is why ptt needs to be monitored.

[nursynurseRN]

I give the bolus, start the infusion and check the ptt 6 hrs after I have the bolts and the go from there

[whitecat5000]

We have a facility policy regarding Heparin that explains when to check aPtt, when to bolus, etc.

Did you check to see if your hospital has one? It could be different per hospital.

[Sun0408, ASN, RN]

Bolus, start gtt then 6 hours later a PTT is drawn per our policy..

Each facility is different, one hospital I worked for did not draw a PTT prior to the bolus while the other one did.. Check your facilitys' policy, or order sheet.. Ours is a pre set order sheet.. Weight based give X amount bolus, then depending on why the heparin is needed; the order sheet will state how much each hour and what to change the rate to after each PTT.

[tokmom, BSN, RN]

All places are usually different. Check your facility. We draw a baseline labs and then bolus prn and do the drip. We do one right after the other, so the Anti Xa is drawn 6 hrs after any change or start.

[SaoirseRN]

We have a pre-printed order sheet/protocol for all heparin drips and the instructions on it are very clear. See if your facility has one, and if not, check with pharmacy and lab to see what they suggest.

[turnforthenurse, MSN, NP]

Every facility is different and they should have their own heparin protocol in place. We need to make sure there is a baseline CBC, PTT, PT/INR and heparin assay documented in the chart. You bolus (unless the physician doesn't order a bolus), start the gtt and per my hospital policy, we have to get a heparin assay level Q6H until we have two therapeutic levels, then it can be Q24H. There needs to be a daily CBC, PTT, PT/INR done.

Make sure you teach your patients about s/s bleeding and assess for any neurological changes. Keep an eye on the platelet count, too, as the patient may develop HIT (heparin-induced thrombocytopenia).

[PedRN86]

I would interpret that as giving the bolus then start the infusion immediately afterwards, then do the level 6 hours post bolus. I would clarify with the doc/NP and the policy and procedure prior to performing either though. Never assume!