Published Sep 18, 2002
What is your protocol on monitoring APTTs on patients with heparin gtts?
Do you differentiate between standard nomagram and a modified nomagram.
I have seen too many people bleed or develop large hematomas because thier APTT has not been checked for more than 6 hours and it is way over limit.
Any imput would be greatly appreciated as I am trying to change our practice to make it safer.
We check PTTs Q6hrs until we get 2 PTTs that are therapeutic. Then, they get checked every day. If the gtts need to be changed again...check 6 hrs after the change and ....need 2 more therapeutic PTTs until its every AM again. We have two different protocols to follow. Stroke and Cardiac. I think the therapeutic levels are different for each. Both initial gtts. are based on pt. wt.
BadBird, BSN, RN
We check PTT 4 hours after a bolus and drip have started, when therapeutic them just QAM, anytime you need to titrate up or down then you check PTT 6 hrs after that.
whipping girl in 07, RN
We do it the exact same way as KC CHICK.
We check q4 until we have 2 therapeutic, then qAM. Sometimes, if a bolus and drip increase is required for a subtherapeutic level, we don't give the bolus, we just up the drip. Nursing judgement.
We initially go by the patients weight..actual not stated and then according to that we give a bolus and start the gtt accordingly then do PTT's q6h until therapeutic then it would be qam from that point on....
Originally posted by KC CHICK We check PTTs Q6hrs until we get 2 PTTs that are therapeutic. Then, they get checked every day. If the gtts need to be changed again...check 6 hrs after the change and ....need 2 more therapeutic PTTs until its every AM again. We have two different protocols to follow. Stroke and Cardiac. I think the therapeutic levels are different for each. Both initial gtts. are based on pt. wt. Anne
Same here. If value >150 is obtained the gtt is off for 30min and another PTT drawn p the 30min then restart per the protocol.
Yup, we have a separate protocol and MAR for heparin gtt with the parameters on it. We write up the orders for the APTT draws "per heparin protocol" and can always put in a stat draw if we suspect any problems. The lab's usually real good about getting it back to us quickly too; can draw and get results within one hour.
Very important on a tele floor.
We check 6 hours after bolus and starting gtt. Then we have a protocol sheet with different ranges. We check 4 hours after any changes. When it is theraputic it will be checked every am.
If someone has a minute could you please give me an example of values concerning monitoring aPTT levels on a patient receiving Heparin. I know the basics of the "normal range is between 20-45 seconds," and the "therapeutic level should be at 1.5-2.5 x the control"...but I'm having difficulty putting that into practice.
Thank you for any response. :nuke:
BBFRN, BSN, PhD
Here is a very good example of a best practice protocol sheet for weight based heparin. Check with your facility's protocol to make sure it's the same before using. I think it lays out the protocol in an easy-to-understand manner.
Does your facility use a protocol sheet? If not, they really should.
ghillbert, MSN, NP
I work with VAD patients - we use a "postop" (low dose) and a "DVT" (high dose) protocol.
Heparin dosing should be very exact based on nomograms - I can't believe someone does it according to "nursing judgement"!!
Create well-written care plans that meets your patient's health goals.
This study guide will help you focus your time on what's most important.
Choosing a specialty can be a daunting task and we made it easier.
By using the site, you agree with our Policies. X