Protocol for Heparin gtt, primary or secondary?

[med/oncRN]

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]

Should be primary.

[Tweety, BSN, RN]

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]

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

[RN1982]

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]

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]

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:

[iluvivt, BSN, RN]

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]

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]

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]

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]

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.