Heparin safety

[mgaynor]

Do any other hospitals use a two RN check for IV Heparin administration? If you do is it a policy or a recommendation? How detailed is the process? How is compliance monitored?

[nminodob]

We use 2 nurses as a policy when administering heparin in any of its forms. If it's in SQ form we chart the location on the body as well. This is a policy created in response to some sentinel event or other (like most all policies).

[AuntieRN]

We also have to have 2 RNs witness and sign when using heparin. It is part of our heparin protocol and a new policy at our hospital.

[Jdl2002]

We do for IV heparin. 2 RNs are supposed to calculate the weight based heparin independently and be present when the IV pump is set. No second RN needed for sq. Our standard sq does in 5000 units, which comes in a one use vial.

[perfectbluebuildings, BSN, RN]

So by IV heparin... do you all double-check heparin flushes too, like for central lines, or just for heparin drips/infusions?

[starletRN]

Our facility requires 2 RNs for heparin drips. No second RN for flushes.

[KristiePDX]

2 RN check for

SQ heparin, LMWH (most all come in pre-filled syringes/exact dose),

any warfarin admin and must ask what the INR is and enter value into pyxis,

and any Heparin IV bolus, or when starting a drip, or with a rate chnage.

Integrelin

Any insulin admin sq or iv /insulin gtt rate change

Starting any cardiac gtt

We use NS for flushes.

[Chewie_123]

All heparin is witnessed/signed by two RNs.

No longer using heparin flushes.

[starletRN]

I'm a new RN and just learning, so I'm curious, what is the rationale for not doing Heparin flushes?

[NC29mom, ASN, LPN, RN]

it is so scary how closely the iv heparin used for "hep-lock" and "heparin sodium injection" so closely resemble each other. one label is dark blue, one lable is light blue. the only other difference is that the hep-lock has a green cap. i think the heparin sodium injection should have a red cap - too many mistakes have been made with this drug. we definitely use 2 checks when using this drug.

[NC29mom, ASN, LPN, RN]

I'm a new RN and just learning, so I'm curious, what is the rationale for not doing Heparin flushes?

Some facilities feel like the small amount of heparin could cause more problems than good (ADR or issues with Pt's that have hx of bleeding disorders) & feel like as long as the peripheral line is flushed with saline in compliance with the facility policy (Qshift or whatever) - the line should remain patent.

Great EBP article @ http://intqhc.oxfordjournals.org/cgi/content/full/18/3/183

In my facility we use saline flushes only for heplocks (or really they are called saline locks), but we always use heparin flushes for PICC lines (remember SASH?).

[Mrs.Rollins, ASN, RN]

We use only saline flushes for all lines. For heparin gtt our protocol requires 2 RN's to calculate and show math, then a third check w/ pharmacy. 2 RN's also have to sign on eMAR. There is no co-sign required for LMWH. The showing your math X 2 bit happened after a sentinel event here in the spring.