Heparin IV Administration

[NurseNibbles]

Please, can someone offer rationale for administering heparin into an existing primary line (such as NS) using the port most proximal to the patient. I can not find any reliable evidence based information regarding this. Or maybe I am thinking too much....I was told that errors have occured where heparin was administered too quickly because of using piggyback method where the heparin is hung as a secondary, physically higher than the mainline of NS. Apparently, this error occured with the use of a smart pump. Help me, I really do not understand. There must be a different reason for administering Heparin using the port most proximal to the patient? Thanks!

[CNL2B]

I'm not sure what your question is exactly. At my facility we run heparin alone, but if you wanted to plug it into a maintainance IV, keeping the heparin on it's own pump, you could ( at the lowest port -- is that what you are talking about?) Not sure specifically what the advantage of that would be unless you only had one IV port to work with. If you have to do this, you always want to plug the drip into the lowest port so if you hang a piggyback on the maintainance, it doesn't flush in a whole big line of heparin. Is that your question? Sorry, took me a minute to think through what you were asking.

One would NEVER, EVER hang heparin as a secondary. That would be a big huge med error.

[NurseNibbles]

Thank you for your reply. I am primarily looking for the rationale for NOT running Heparin as a secondary (IVPB). I can not find any documentation supporting this, and I am not sure what the error is. It isn't obvious to me, you say it is a 'huge med error', that means it is obvious to you, please share why. I was told that Heparin is not administered as a IVPB because an entire bag of premixed heparin was given to fast somewhere, and a smart pump was used, with Heparin was running as a piggyback at the time, and no other IV medications were prescribed, just Heparin.

Part of your answer did offer some rationale, for example, administering the antibiotic via a completely seperate line, as not to flush existing Heparin quicker than prescribed. That definately makes sense to me. Thanks again!

[CNL2B]

I don't see why you would ever, under any circumstances run a gtt as an IVPB. It hangs higher than the primary that way and is going to run in first. What if the rate you set your primary at is faster than the secondary, and the secondary med time is up and it switches over to the primary?

I guess I still don't understand totally what you are asking. I have never seen this done in practice as everybody knows that if you do this, it has a huge potential for harm. You might find literature (if that is what you are looking for) on how to run high-risk, drip-based medications (not just heparin) -- and likely they are going to tell you to run it on its own for safety reasons.

[meandragonbrett]

The whole point is that you need to run Heparin on a totally separate pump. Not as a secondary or piggyback (Depending on your pump depends on the terminology). It's just entirely too easy to make errors when changing the rate of the gtt.

So MIVF on one pump. Heparin gtt on a separate pump. Y-site away!

[NurseNibbles]

I hear ya! Thank you. And I completely agree!

When we were talking about this at work, a co-worker of mine (a senior nurse) told me that Heparin is run on its own pump, by itself, with its own dedicated line because 'once upon a time' an error had occured, where Heparin was given IVPG, using a pump with 'smart technology' where you access software that is specifically made to identify what you are administering (Heparin) with everything you would want already programmed in the pump specific to the drug you are giving (preprogrammed with concentration of 25,000 units per 250 mL pre-mixed bag of Heparin...you can also enter the patients weight to ensure the dosage is congruent with the patients weight). Somehow, even this system failed, and the Heparin was given much too fast (250 mL in an hour)! So, under this explanation, in my mind, this unfortunate error could occur if Heparin was running on its own dedicated line through the same pump?

I guess my co-worker has me feeling that you are damned if you do and damned if you don't! One day, younger nurses are going to ask me why we do the things the way we do, and I would like my answer to be better than what I was given :)

Cheers!