Heparin Drip Maintenance

DO DOCS EVER ORDER A CONTINUOUS HEPARIN DRIP WITHOUT FOLLOWING A WEIGHT BASED PROTOCOL (EX. 1000 U/HR) AND WITHOUT ANY PTTs ORDERED????? I HAVE BEEN TOLD THIS SITUATION CAN HAPPEN (BUT FORTUNATELY HASN'T HAPPENED ON MY SHIFT) AND THE DOC DOES NOT WANT THE DRIP ADJUSTED. CAN'T IMAGINE THAT! BUT WANT TO LEARN AHEAD OF TIME AND FROM EXPERIENCED NURSES. THANKS FOR YOUR HELP.

[Reabock]

NO!

[Tweety, BSN, RN]

I've seen docs order heparin drips to start at a rate and leave it there. But not necessarily without doing at least daily ptt's.

We have three heparin protocols: medical, cardiac, and stroke and the docs are more than happy to use them.

[gwenith, BSN, RN]

Regular APPT's are essential. Every so often out of the blue the patient will develop HITS - heparin induced thrombocytopenia Syndrome. Below is an exerpt from the Merck Manual online.

This Publication Is Searchable

The Merck Manual of Diagnosis and Therapy

Section 11. Hematology And Oncology

Chapter 133. Platelet Disorders

Topics

[General]

Thrombocytopenia

Platelet Dysfunction

Heparin-Induced Thrombocytopenia

Heparin-induced thrombocytopenia, the most important thrombocytopenia resulting from drug-related antibodies, occurs in up to 5% of patients receiving bovine heparin and in 1% of those receiving porcine heparin. Rarely, patients with heparin-induced thrombocytopenia develop life-threatening arterial thromboses (eg, thromboembolic occlusion of limb arteries, strokes, acute MI).

The thrombocytopenia results from the binding of heparin-antibody complexes to Fc receptors on the platelet surface membrane. Platelet factor 4, a cationic and strongly heparin-binding protein secreted from platelet alpha granules, may localize heparin on platelet and endothelial cell surfaces. In addition, platelet factor 4-heparin complexes are the principal antigens. Platelet clumps can form, causing vessel obstruction.

Heparin should be stopped in any patient who becomes thrombocytopenic. Because clinical trials have demonstrated that 5 days of heparin therapy are sufficient to treat venous thrombosis and because most patients begin oral anticoagulants simultaneously with heparin, heparin can usually be stopped safely. Laboratory assays do not aid these clinical decisions.

[P_RN, ADN, RN]

That would be a recipe for disaster and a BIG malpractice suit!!

[nimbex, RN]

We do both weight and non-weight based heparin. The LEAST infrequent aPPT's are each am, AFTER a therapudic level has been achieved.

What does your policy state? Our pharmacy doses weight based. Do you have a clinical instructor or nurse clinician?

let us know

[nowplayingEDRN]

If the heparin drip is ordered without any checks then maybe you need to question the doctor about it. However, it is far from safe and the hospital policy to use weight based dosing should always be followed. Our hospital policy states that with our weight based heparin dosing, until the ptt is theraputic, as long as the dosage is being adjusted, the ptts get checked every 6hours and with every change.....It is dangerous not to monitor the ptts.

[renerian, BSN, RN]

Yes I have seen non adjusted drips. If the doc does not want PTTs, ask him and if he says no document your request and the denial of an order to be given, that way you CYA.

renerian

[stella123 rn]

We have a heparin drip protocol. All the doctor has to do is write "heparin drip protocol" on the order sheet and we do the rest. It dictates how often ptt have to be drawn and when to adjust the rate. The doctors do not have to do anything. We just order the labs and write a protocol order.

[New CCU RN]

If a patient is in DIC, there are times when they will run the drip at a very lose dose like 200u/hr.