HIT in Pediatric Patients

[mabell52]

There is some discussion in our PICU about the continued use of Heparin in our art and cvp lines. What is the practice out there in other PICUs? Have you had many cases of Heparin Induced Thrombocytopenia in your pediatric patients.

[NotReady4PrimeTime, RN]

We're still using heparin. Our art lines are 1 unit/mL NS at 3 mL/hour on a pressure bag for kids over 10 kg and 2 units/mL at 1 mL/hr on a pump for kids under. CVP and LA lines are all 1 unit/mL in dextrose, 5% for kids over 10 kg at 3 mL/hr on a pressure bag and 10% at 1 mL/hr on a pump for kids under... The evidence suggests that heparin is not needed even for central lines so our practice may change someday, but I'm not holding my breath. Our incidence of HIT is very low. I can't recall a single kid that we worked up for it actually having it, even our ECLS kids.

[kessadawn, BSN, RN]

we're still using heparin. our art lines are 1 unit/ml ns at 3 ml/hour on a pressure bag for kids over 10 kg and 2 units/ml at 1 ml/hr on a pump for kids under. cvp and la lines are all 1 unit/ml in dextrose, 5% for kids over 10 kg at 3 ml/hr on a pressure bag and 10% at 1 ml/hr on a pump for kids under... the evidence suggests that heparin is not needed even for central lines so our practice may change someday, but i'm not holding my breath. our incidence of hit is very low. i can't recall a single kid that we worked up for it actually having it, even our ecls kids.

we still use heparin as well, pretty much the way jan does in her unit, except that we always have it in saline, never a dextrose solution. i will say, however, that we rarely have la or pa lines, but our cvp fluid is always saline. we only have 2 solutions: heparin in ns at 2units/cc, and heparin in 1/2 ns that we always run in cardiac post ops. no probs with hit as yet, i've been working here over 3 years.

[NotReady4PrimeTime, RN]

We use dextrose on the tinies because often they're so fluid restricted after surgery that the only IV fluid they get is from their pressure lines and drug infusions. We're trying to prevent hypoglycemia!

[PICNICRN, BSN, RN]

We, too, use heparin for our monitor lines. Mixed 1:1 with NS. Bigger kiddos get 3cc/h and the bitty ones get 1cc/h. Sometimes we add papaverin to the bag if the A line blanches.

Can't say I've ever seen HIT in my carreer.

[slcpicu]

we almost use heparin in our lines extactly as Jan described besides it's always 1:1 regardless of size. I have seen HIT in a few cases but out of the 400 plus cv surgeries I have seen only a handful of cases. We haven't changed our practice with those few cases. Just used argatroban in those pts.

[tryingtohaveitall]

Several years ago we changed from 1:1 heparin to the premix 2:1 for our a-lines and CVPs. Most run the 3ml/hr from the standard setup, but if it's a teeny tiny we'll put it on the NICU setup that runs at 1ml/h. Years ago we had heparin in our Hal/TPN, but no longer. I can't recall seeing HIT.

[Heather91001]

We use 2units/cc heparin for our A lines & for our cardiac CVP. Regular kids get NS for their CVP. Infants it runs at 0.5cc/hr & older kids at 1cc/hr. We never have problems with clotting or HIT.