Heparin drips

justblink · Jul 17, 2008

Our protocol is this: Anti X-A is drawn six hrs after initiating therapy; if sub-therapeutic, we follow the pre-printed bolus orders, bump up the units per hour, and put in another Anti X-a 6 hrs after changing the dose.

If the Anti X-a is within therapeutic range, we just draw another Anti-Xa with the A.M. labs.

Just remember that Heparin's half-life is short.

Oh, and regarding boluses: sometimes, they'll have us bolus 5,000 units SQ. Other times, it'll be with IV heparin.

brown rice · Jul 17, 2008

Thank you I appreciate that response. We also do this at our hospital.

Are there any medical conditions that I should be particularly aware of when monitoring pt.'s on heparin drips?

Besides the obvious of pt.'s being out of PTT range what other reasons would cause one to turn off the drip?

Of course we are monitoring for bleeding.....

CritterLover, BSN, RN · Jul 17, 2008

don't forget to keep an eye on platelet count, too.

heparin-induced thrombocytopenia (hit) is becoming more and more common.

generally, platelets should be checked at least q3 days while on heparin therapy, and action should be taken if counts drop to less that 1/2 the baseline (pre-heparin) count (or to less than 100, if the initial count was fairly low)

Creamsoda, ASN, RN · Jul 17, 2008

Make sure you monitor the patients neuro status, just incase they start bleeding. You never know. If they start acting confused, and previously werent, somethings probably wrong. I had a patient on Reo-pro (different mechanism) post angioplasty, be fine post procedure. Got a bit confused, pupil changes. Went for stat CT, after they got back, much more obtunded, responsive to painfull stimuli only. Bled out big time into her head. Was only in her 50's and died the next day. Nothing they could do, despite catching things early. Ive never seen it happen with heparin, but I havent been around that long, but im sure it could happen.

romantic · Jul 17, 2008

beautiful photo and quote.

romantic · Jul 17, 2008

"platelets should be checked at least q3 days while on heparin therapy"

look for the signs of ecchymosis -- internal bleeding.

"bled out big time into her head. was only in her 50's and died the next day."

i read that heparin therapy is a risk factor for intracranial hemorrhage in elderly (50 years old doesn't look to me as an old person. you never know...)

romantic · Jul 17, 2008

You can look for the signs of internal bleeding by noticing an increase in ecchymosis.

I read that heparin therapy is a risk factor for intracranial bleeding in elderly patients (50 years old doesn't look elderly to me... you never know...). Watch for confusion in a patient who had clear mind before.