Heparin Protocol

This really should be something that your unit has on hand ... every hospital is different in regards to Heparin and its adjustments (i.e., does the MD have his/her own protocol, is the sliding scale for the PTT variable, do they use the IIB/IIIA protocol for concommitant plt inhibitors ...). This is a website that will do the calculations for you http://www.medcalc.com/heparin.html but I'm pretty sure you want a written out protocol. This one is for ischemic stroke patients (which is pretty close to the DVT/PE protocol). http://www.emermed.uc.edu/stroketeam/PDF%20files/Heparin%20dosing%20chart.pdf

If I were you I would just find a blank MD order on the unit, take it home and practive the caluculations with different wts in kg. Then when it comes time to titrate it, the concept won't be so foreign.

Hope this helps.

This really should be something that your unit has on hand ... every hospital is different in regards to Heparin and its adjustments (i.e., does the MD have his/her own protocol, is the sliding scale for the PTT variable, do they use the IIB/IIIA protocol for concommitant plt inhibitors ...). This is a website that will do the calculations for you http://www.medcalc.com/heparin.html but I'm pretty sure you want a written out protocol. This one is for ischemic stroke patients (which is pretty close to the DVT/PE protocol). http://www.emermed.uc.edu/stroketeam/PDF%20files/Heparin%20dosing%20chart.pdf

If I were you I would just find a blank MD order on the unit, take it home and practive the caluculations with different wts in kg. Then when it comes time to titrate it, the concept won't be so foreign.

Hope this helps.

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It has nothing to do with your topic but is that a Viszla (spelling)? OMG. I have a Weim and I love your dog too. Let me know. I have alot of ???'s.

Thanks,

Sarah

My advice...follow protocal it does very. Use the pharmacy as a resouce as needed. Check and recheck your calculation as well as those before you. LOOK at your labs!!! PT/INR..monitor other anticoags..asa, coumadin dose daily, plavix...see the BIG picture

Is it true you can never piggyback heparin in to a mainline ,and then run the heparin through the pump. A cohort told me this and am just wondering if this is accurate. I wanted to Y the heparin into another line and run it through the pump, but she says no. Any ideas??

We always run heparin through a pump. Not as a piggyback, however. We either titrate heparin according to the PTT or we may have a set rate.

Would you trust your skills to try to eyeball a rate on something that is as intricate and as vital as a heparin rate??

We'll run heparin into another line, say nitro, as a Y, but always on a pump. I would think it would be protocol to run it thru a pump. Our pumps will actually do the calculations for you, but I'll always double check.

I know our protocol for ACS shoots for a PTT around 75...don't remember the exact range. We titrate based on the PTT then schedule labs around that.

Cheers,

Tom

Anyone using heparin anti-Xa labs now instead of PTT? Our heparin protocol still uses PTT, but some orders say "pharmacy to manage" and whatever their protocol goes by uses the anti-Xa result.

Heparin protocols are CRAZY! Every where I go it's something different....Cruikshank, weight-based, some personal kind, just anything. What drives me craziest is the differing concentrations of heparin. I was always used to a 1:1 which makes the titration easy, but lots of places use some other concentration and it gives this traveler a headache. I think standardization of this sort of thing, maybe not just heparin but a lot of drugs, is something JCAHO could look at rather than some of the craziness they do.

Yup, the many concentrations of Hep gtts must be a source of errors. Within facilities, I believe the #'s of choices are limited, but between facilities, watch out, agency/travelers!

It is okay to Y a Heparin gtt into another line, as long as the Heparin is on a pump.

Is it true you can never piggyback heparin in to a mainline ,and then run the heparin through the pump. A cohort told me this and am just wondering if this is accurate. I wanted to Y the heparin into another line and run it through the pump, but she says no. Any ideas??

I think this person was asking if it was ok to run the heparin thru a pump but Y it into the main line. I dont think she/he meant to run the heparin off the pump.

I understand why your "cohort" told you that you cannot do that. The reason she probably said you couldnt do it was because if you are running any IV piggyback antibiotics thru that main line you are increasing the flowrate of the main IV and therefore your patient would get a bolus of the med that is Y'ed into the main line. That therory goes for any drug that you would Y into a main line IV. The other reason that I don't like to Y any drug into the main IV is compatibility issues. There are some meds that are not compatible with certain antibiotics and there is a chance that someone will hang a antibiotic piggyback with the main IV and a incompatible drug will be Y'ed into the main IV and that particular nurse just might not think about checking compatiblility with something that is Y'ed into the site.

I think this person was asking if it was ok to run the heparin thru a pump but Y it into the main line. I dont think she/he meant to run the heparin off the pump.

I understand why your "cohort" told you that you cannot do that. The reason she probably said you couldnt do it was because if you are running any IV piggyback antibiotics thru that main line you are increasing the flowrate of the main IV and therefore your patient would get a bolus of the med that is Y'ed into the main line. That therory goes for any drug that you would Y into a main line IV. The other reason that I don't like to Y any drug into the main IV is compatibility issues. There are some meds that are not compatible with certain antibiotics and there is a chance that someone will hang a antibiotic piggyback with the main IV and a incompatible drug will be Y'ed into the main IV and that particular nurse just might not think about checking compatiblility with something that is Y'ed into the site.

Good point, I didn't think to mention it but of course it's important to ALWAYS check drug compatibility before combining any drugs. I'm kind of a freak about it, do it automatically, so didn't think to mention it :)

When I would Y Heparin into another line, it would be something like NTG, where I knew I wouldn't be running any Abx or anything else that would increase the flow rate. Hope we actually got the OP questions answered!