Pediatrics and Heparin IV Calculations -- Please Help!

[Jeana18, MSN, DNP, RN, APRN, NP]

Hi Everyone:

I'm currently at the end of my most difficult course in Nursing, all Med-Surg. I had a rotation on the Pediatrics floor and had a 2 week old neonate as my patient. I am required to do calculations for the Heparin that was given but can't seem to find the correct Safe Dose Range reference of numbers :/

Here is the information I do have:

Heparin

250mL bag NaCl 0.225% + 1unit/mL @ 2mL/hour

All of the ranges I come across refer to 0.5-2 units/mL in a 250mL bag and 28units/kg/dose for maintenance with the running IV at 1-2mL/hour. Is anyone familiar with this type of calculation? Know where to direct me? Or how to explain the circumstances?

When I calculated the 28 units/kg/dose my instructor said it came to 1.08 mL and stated that I needed to recalculate the medication.

Thanks in advance!! :)

[Laurie52]

Hi Everyone:

I'm currently at the end of my most difficult course in Nursing, all Med-Surg. I had a rotation on the Pediatrics floor and had a 2 week old neonate as my patient. I am required to do calculations for the Heparin that was given but can't seem to find the correct Safe Dose Range reference of numbers :/

Here is the information I do have:

Heparin

250mL bag NaCl 0.225% + 1unit/mL @ 2mL/hour

All of the ranges I come across refer to 0.5-2 units/mL in a 250mL bag and 28units/kg/dose for maintenance with the running IV at 1-2mL/hour. Is anyone familiar with this type of calculation? Know where to direct me? Or how to explain the circumstances?

When I calculated the 28 units/kg/dose my instructor said it came to 1.08 mL and stated that I needed to recalculate the medication.

Thanks in advance!! :)

Need to know how much the baby weighs.

[Halcyonn]

I haven't taken any drug dosage classes, but wouldn't you need to convert kg to mL and then calculate?

[jrenea]

Hi Everyone:

I'm currently at the end of my most difficult course in Nursing, all Med-Surg. I had a rotation on the Pediatrics floor and had a 2 week old neonate as my patient. I am required to do calculations for the Heparin that was given but can't seem to find the correct Safe Dose Range reference of numbers :/

Here is the information I do have:

Heparin

250mL bag NaCl 0.225% + 1unit/mL @ 2mL/hour

All of the ranges I come across refer to 0.5-2 units/mL in a 250mL bag and 28units/kg/dose for maintenance with the running IV at 1-2mL/hour. Is anyone familiar with this type of calculation? Know where to direct me? Or how to explain the circumstances?

When I calculated the 28 units/kg/dose my instructor said it came to 1.08 mL and stated that I needed to recalculate the medication.

Thanks in advance!! :)

I hope this helps

Volume (ml) X (ml/hour)

Your patient has a DVT is ordered for a heparin infusion to start at 18 units/kg/hour per the practitioner’s order. His weight is 75kg. The heparin infusion comes in a 500ml bag with 25,000 units. Calculate the starting rate of the infusion (ml/hour).

Step 1: Calculate the starting units per hour. 18 units X 75 kg = 1350 units/hour

Step 2: Calculate the starting rate of the Infusion (solve for X).

Heparin Infusion Rate: 25,000 units = 1350 units/hour 500ml X (ml/hour)

25,000 units (X ml/hr) = 675,000

X ml/hr = 675,000 25,000

X = 27 ml/hour

[KelRN215, BSN, RN]

How much does the baby weigh? That's an essential part of this equation that is missing.

[Jeana18, MSN, DNP, RN, APRN, NP]

Sorry! The baby weighs 3.605 kg.

[Chrono, BSN, RN]

so if we go with the numbers you provided, and 4 kg for the infant's weight (since no number provided)

28 units/kg/hour * 4 kg * 1mL/1 unit = 112 mL/ hr.

I assume the issue is that you have the incorrect concentration for heparin, it's more likely 100 units/ mL (at least that's all I ever see it as for adults). Based off of the number your clinical instructor came back with that is probably the concentration also.

[Jeana18, MSN, DNP, RN, APRN, NP]

Sorry. Forgot to put the weight, 3.605 kg. I think the issue is finding a correct safe dose range reference. Any help is appreciated, thanks everyone.

[NotReady4PrimeTime, RN]

I am required to do calculations for the Heparin that was given but can't seem to find the correct Safe Dose Range reference of numbers :/

Here is the information I do have:

Heparin

250mL bag NaCl 0.225% + 1unit/mL @ 2mL/hour

All of the ranges I come across refer to 0.5-2 units/mL in a 250mL bag and 28units/kg/dose for maintenance with the running IV at 1-2mL/hour. Is anyone familiar with this type of calculation? Know where to direct me? Or how to explain the circumstances?

When I calculated the 28 units/kg/dose my instructor said it came to 1.08 mL and stated that I needed to recalculate the medication.

Thanks in advance!! :)

Okay. The formula you've given for the heparin infusion (250mL bag NaCl 0.225% + 1unit/mL @ 2mL/hour) is the concentration typically used to maintain patency of IV access. At 2 mL/hr this baby is receiving 2 units of heparin per hour or 48 units per day. This is negligible.

When infusing heparin for other reasons, such as maintaining cardiac shunt or hepatic circulation patency, or for thrombus prophylaxis, the 28 units/kg is an hourly dose run as a continuous infusion. That's the standard dose for those indications. So you would need to calculate the rate this way: (we'll use 4 kg as our example weight)

4 (kg) x 28 (units/hr) = 112 (units/hr)

With the concentration of heparin in your bag (1 unit/mL) for anything other htan line patency this baby would need 112 units or 112 mL per hour which is too much fluid for any infant. My unit uses a pharmacy-prepared solution that has a concentration of 100 units/mL, which for this patient would then run at 1.12 mL/hr.

I think you need more clarification of this that you've provided here.

[Jeana18, MSN, DNP, RN, APRN, NP]

so if we go with the numbers you provided, and 4 kg for the infant's weight (since no number provided)

28 units/kg/hour * 4 kg * 1mL/1 unit = 112 mL/ hr.

I assume the issue is that you have the incorrect concentration for heparin, it's more likely 100 units/ mL (at least that's all I ever see it as for adults). Based off of the number your clinical instructor came back with that is probably the concentration also.

Thanks for your help. That makes a lot more sense I'm starting to think that I wrote that down instead of the right number. I will have to double check somehow.

[NotReady4PrimeTime, RN]

Threads merged.

[Jeana18, MSN, DNP, RN, APRN, NP]

Thank you. I definitely may have written down the wrong number. The 100 units/mL makes much more sense. I will talk to my clinical instructor and clarify with her. Thank you everyone for your wonderful help!! It's greatly appreciated; spent hours pondering what was wrong.