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Protocol for Heparin gtt, primary or secondary?

Posted

Specializes in med/surg/ortho/school/tele/office. Has 6 years experience.

Can anyone tell me what is "the norm" for hanging a heparin gtt as far as it being hung as primary or secondary on the pump?(no other fluids are ordered) My facility doesn't have it in writing. The last hospital I worked at always had us hang it as a primary with a secondary tko of NS. Their reasoning was that the pump would not continue with an empty bag. Where I work now it is hung either/or. I figure you need to be cautious with your rates and always double check, so does it matter?

jmgrn65, RN

Specializes in cardiac/critical care/ informatics. Has 16 years experience.

Should be primary.

Tweety, BSN, RN

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac. Has 28 years experience.

We hang Heparin alone as a primary fluid, in a designated IV site, without any other fluids.

If a patient has poor venous access and we can only get the one line, if the fluid or medication we need to give is compatable then we'll piggy back, but only if we can't get another line. Almost always Heparin is given alone on a pump. The pump should alert us when it's time to hang another bag.

nerdtonurse?, BSN, RN

Specializes in ICU, Telemetry.

I always try to have a second site -- if I can't I'll try to get a PICC or a TLC ordered.

RN1982

Specializes in ICU/Critical Care.

Heparin is a high-alert drug. Should be hung primary and I don't see the need for it to be hung with KVO IVFs. I usually infuse it through it's own IV or port.

miss81, BSN, RN

Specializes in Surgery, Tele, OB, Peds,ED-True Float RN. Has 8 years experience.

We always hang it as a primary infusion. Once we had a nurse hang it as a secondary med and the pt's PPT was all out or whack. We soon found out that the heparin bag was dry and the NS was running for several hours. I know that she should have been checking it frequently but our surgical unit has a 8:1 or 10:1 ratio so sometimes stuff slips through the cracks! I know that the drip runs fairly slow so it makes since to run a KVO line too but it really is safer to run it as a primary infusion.

Bocephus71RN-BSN, BSN, RN

Specializes in med-surg, telemetry,geriatrics. Has 15 years experience.

should be as a primary always for safety. if the bag goes dry it will alarm. Like tweety said. I once followed a nurse who ran in an entire bag of Lepirudin which should have lasted 24 hours in less than an hour it is given to people sometimes that have heparin induced thrombocytopenia. It ended up leading to the lady's final demise.:down::down::down::banghead::scrying:

iluvivt, BSN, RN

Specializes in Infusion Nursing, Home Health Infusion. Has 32 years experience.

YES run it as a primary...there is no need to hang a NS bag on a KVO rate...even 0.5 ml per hr will keep a CVC open....I do not think RNS realize that...... but it is true. iIdo it all the time in home care......we infuse even 0.1 ml at a continuous rate inbetween timed doses of antibiotics and our CVCs and pICCs never clot off

widi96

Specializes in Emergency Dept. Has 10 years experience.

Heparin is to be in the primary. We aren't big on having secondary access though if whatever else you need to infuse is compatible with the Heparin. Just never on the same pump. We have the Heparin on a Primary line and hooked up to the patient's IV - take a second pump with your flush and antibiotic or whatever and just hook it to the closest port of the tubing with the Heparin going in it.

floatRN

Specializes in Med-Surg. Has 4 years experience.

I have seen nurses hang heparin and continuous IV fluids on the same pump with heparin as primary and IV fluids as secondary. This drives me crazy. Way too much room for error. Even if running the two in the same line, heparin should always have its own pump for safety. Same goes for morphine drips etc. I am way too scared I would mess up programming the pump and end up running the med at 100ml/hr or something.

RN1982

Specializes in ICU/Critical Care.

I don't have a problem with hanging heparin on a pump with IV fluids. The only error is if someone isn't paying attention to what they are doing. We can set the pump to label each IV on the pump and we use the Baxter triple pumps so I always keep the lines labeled and the pump labeled.

nightshift82

Specializes in CCU. Has 33 years experience.

Only drugs we have running as piggyback or secondary are antibiotics. If a drug was compatible w/ heparin, dopamine, levo,etc that is to be attached at the Y site below the pump and then that drug would be running on it's on designated pump. It has been a policy for at least 15 years because of the above mentioned incidents.

med/oncRN

Specializes in med/surg/ortho/school/tele/office. Has 6 years experience.

Thanks guys. I was pretty sure it was supposed to be primary. I had the feeling that the Heparin was supposed to be primary like I had been taught at my prior facility. Thanks for making it clear.

By secondary, do you mean as a piggyback? If so, I'd never run heparin that way. I'd run it through its own pump module and then attach it to flush line running NS, D5 or a compatible hydration fluid. I only ever run antibiotics as piggyback, anything else, such as electrolytes or heparin or tacrolimus, etc., I would run through its own module. That way the pump will beep when the infusion is near completion. That way the pump will beep near completion to alert you so you can make sure a new bag is added (although for heparin we usually hang 500 ml bags that are changed Q24 and we never get near the end of one). For electolyte riders we can also make sure that the line doesn't run dry so we can easily do a flush following (you can lose close to 1/4 of a dose if you don't do this, at least how our facility administers it). Also, I suspect there are fewer programming errors this way

Edited by firstyearstudent

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