Heparin Drip Protocol - Primary or Secondary

[Murser]

Hello all. I am currently in my final semester of nursing school and am looking for some help with a Quality Assurance project that I am working on. My area's regional hospital is currently trying to revise their heparin drip protocol to include verbiage stating whether heparin drip needs to be infused through a primary line via pump, or secondary line with the primary line being NS running at a TKO rate. I have not been able to find much with regards to peer-reviewed evidence-based research articles in the topic. I thought I would turn to my nursing community and see if I can obtain information on current practice. I appreciate any reply, but would really like to see your protocol (if it specifically states primary vs. secondary or not), size of facility, location of facility (city, state, or both), and any other pertinent comments. Thanks in advance!

[classicdame, MSN, EdD]

I cannot share policies but wonder if you have talked to the facility's pharmacist? They probably have data to support their method of delivery

[MunoRN, RN]

We run heparin by itself. The purpose of running a slow running gtt with a carrier fluid is to achieve a sufficient TKO rate, which most studies show is 10-15cc/hr. Our policy is to run a carrier fluid at a rate to equal 15cc/hr (if you're running NTG at 8cc/hr, then you'd run NS at 7 along with that).

Running enough fluid through a line to keep it patent isn't really in issue if you're running heparin at a few hundred to over a thousand units an hour through the line, same goes for other blood thinners such as bivalirudin and integrilin, they are all essentially the ultimate TKO even at very low rates.

BTW, I don't fault you for this since it is a common issue with our terminology, but if you're running two fluids together and they are both on their own pumps then they are both primary infusions, regardless of the fact that one may y-into the other below the pumps; secondary infusions are only those that run intermittently, attach above the pump of the primary fluid, and do not use their own dedicated pump, running through the primary fluid pump instead.

[pajoopie1]

We always run heparin on its own pump. We run it as a primary. We generally don't connect it to any fluids or antibiotics. If we can only get on access on the patient, we will run fluids and antibiotics at the y-site as long as the drugs are compatible.

[nursej22, MSN, RN]

We do the same as pajoopie1: run as a primary on its own pump, only y-ing in other solutions if its the only access and is compatible.

[Nurserton]

We run it as a primary infusion on its own pump. The facility I'm with now has pumps that allow you to pre-program the units/kg/hr to be delivered, presumably eliminating math errors. And, in a dumbed down version of Muno's response, you don't worry about the line clotting off or "KVO" rates because you're running high concentrations of blood thinners through the line.

[ObtundedRN, BSN, RN]

We run it as a primary, and cover the secondary and Y-port with a label that states it is heparin so nobody makes a mistake and connects something to it.