Heparin Drip

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When your patient is on a heparin drip, and aPTT comes back at say 45 and you need to give a bolus...

Do you think it's reasonable to bolus at a Y site closest to the patient? Or do you disconnect and bolus directly into the vein? After bolusing at the Y site, I started to wonder whether my next aPTT would be accurate... A "bolus" is not meant to take an hour to infuse to the pt, so wouldn't this affect the end result? i.e. The result at the 6 hour mark might actually be a bit lower than it would be had the bolus been given in one shot?

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Hmm interesting thought. I always disconnect and bolus directly into the vein or I utilize the bolus function on the pump. From searching around a bit I have seen that others have given their bolus dose through the port closest to the patient which in my opinion would still be appropriate and would more than likely produce an accurate heparin level at the next draw.

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Specializes in critical care.

I pinch the line above the Y, push, then flush and let go. I'm lazy. ☺️

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Specializes in Medical-Surgical/Float Pool/Stepdown.

I always just put it through the closest Y port. With all of the protocols we use, if you're giving a bolus you're having to increase the gtt by so many U/kg/hr anyways so we order the PTT six hours from the rate change/bolus in the MAR. Here's an article that sorta talks about the halflife and has more information than probably anyone ever wanted to know about heparin but I loves me some pharmacokinetics anyways! PS: did you know that running normal saline concurrently with heparin (on a separate pump but hooked the same IV tubing) decreases it's effectiveness by 30 to 50% because of the osmolarity "incompatibility"...http://m.circ.ahajournals.org/content/103/24/2994.full

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Specializes in Critical Care, Med-Surg.

I bolus from bag, using the pump.

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Specializes in SICU, trauma, neuro.

I too do a bolus from infusion--from the pump. It's given over, what, a minute? Not over an hour. Then time the antiXa for 6hr later

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Specializes in MICU - CCRN, IR, Vascular Surgery.

We are to always bolus from the bag by programming the pump per hospital policy.

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We don't bolus from bag but would like too. I use y site closest to pt and pinch above like pp stated

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Like previous poster we can't bolus from bag. I usually disconnect and do it directly into vein. I have also done it Y site and pinched above and flushed.

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