How do physicians decide whether to order IV heparin drips or SC heparin for patients

Hi! I'm a new RN & I was wondering how docs decide to order IV continuous heparin drip versus SC heparin for a pt? I'm just curious.

-Christine

It depends on the clinical reason for the Heparin. Heparin 5,000 units subcutaneous injection q12hr or q8hr are typically for deep vein thrombosis (DVT) prevention.

A Heparin drip is used for several reasons:

DVT treatment - the patient is started on this and it is titrated until their Ptt is therapeutic (60-80), then they are started on Coumadin and that dose is titrated until the INR is therapeutic (2-3). When the INR is therapeutic the Heparin drip is d/c'd.

Pulmonary Embolism (PE) - VQ scans with a high probability result will usually mean that you'll need to start a Heparin drip. I think spiral CTs are replacing the VQ scan as the diagnostic tool of choice.

Pre-op patient who was previously on Coumadin. Heparin has a shorter half-life than Coumadin. It is possible and sometimes necessary to have a patient admitted prior to surgery and on a Heparin drip so as to continue anti-coagulating without the Coumadin on board. This way the Heparin drip can be stopped for about 4hrs prior to surgery and the risk of developing new clots or excessive post-op bleeding is decreased.

Understanding half-life, onset and duration of your meds is important when determining/anticipating what med to give or hold. Your drug guide should also give you a list of routine dosages and indications/usage for this and other meds.

Congratulations and welcome to nursing.:balloons:

Great posts everyone.