Safe Heparin Levels ............:icon_ques

maro · Dec 26, 2005

http://health.yahoo.com/drug/d00252a1;_ylt=An4ToxNaFnPRu1sGS_Lw4gYkD7sF#d00252a1-overdose

Good information on heparin. Let me know if it helps or if you need more info..

Home Health Columnist / Guide · Dec 26, 2005

http://nursing.about.com/od/education/ht/heparininj.htm

http://www.unchealthcare.org/site/nursing/nurspractice/protocols/protocols_pdf/protocolh1.pdf

an interdisciplinary model for reducing intravenous heparin errors

nurseweek: the heparin paradox : :

http://64.233.167.104/search?q=cache:g76a-n8i2lwj:www.ismp.org/msaarticles/heparinalert.html+heparin+%2b+nurses&hl=en

Pediatric Critical Care Columnist · Dec 26, 2005

The "1.5 to 2.5" reference in your question is likely the International Normalized Ratio (INR) which is also referred to as the prothrombin time (PT) in some places. PT is the time it takes whole blood to form a clot. INR is an international standard for reporting PT that is universally understood. A person on anticoagulants post MI/CVA, or with artificial heart valves, or a number of other reasons, will have their PT/INR maintained at 2.0 to 3.0, or sometimes higher, based on their underlying risk of clotting. Our pediatric liver transplant patients typically run their INRs in the 3.0 to 4.0 range, due to the risk of clotting off their grafts. Kiddies with mechanical valves will run around 2.5. Does that help?

(Yes, you could give the heparin if the INR is 1.5 to 2.5!)

spiri1, ADN, RN · Dec 27, 2005

Thank you for responding to my question regarding Heparin, Janfrn,

Would you explain specifically, what 1.5 to 2.5 represents numerically ?

I'm trying to make my question clear and I'm having some difficulty.

Please bare with me.

I think what I need to undersytand is, what are the specific range of numbers that 1.5 to 2.5 represents.

I'm confused when they say the PTT is 35, so its ok to administer Heparin, or its not ok to administer anything over 100.

That is the best example I can think to give in order to explain what I'm trying to ask.

Thank You for your help :Holly2:

Pediatric Critical Care Columnist · Dec 27, 2005

okay, let's see how well i understand it!

prothrombin (coagulation factor ii, a vitamin k-dependent proenzyme that functions in coagulation) time is measured by mixing the patient's blood with thromboplastin (a protease that converts prothrombin to thrombin in the early stages of blood clotting) to see how long it takes the blood to form a clot. there are three commonly used types of thromboplastin used world-wide to run this test... human brain, rabbit brain and recombinant. each is slightly different and therefore will give slightly different results. so a method of "normalizing" the results was necessary to allow for across-the-board accuracy, no matter where the blood is tested. (this is really important in cases where patients are transferred from one facility or state to another, as in the case of trauma patients, transplant recipients and other.) inr (international normalized ratio)

is the solution that was developed by the world health organization. it uses human brain thromboplastin as the benchmark so human brain thromboplastin has an international sensitivity index (isi) or correction factor of 1, rabbit brain thromboplastin has an isi of 2 and recombinant thromboplastin has an isi of 1 as well. the lab knows what type it uses, then applies the isi to the results obtained to come up with the inr. "normal" blood would clot at a given rate (11 to 13.5 seconds, depending on the lab), the value of which would be an inr of 1, regardless of what type of thromboplastin used, because of the correction with the isi. so a value of 1.5 would be 1 1/2 times normal, and so on. does that clear it up for you?

now ptt (partial thromboplastin time) or more likely aptt (activated ptt) is a bit different. in this test a ptt reagent and calcium are added to the specimen and then the timer is started. normal values are 25 to 39 seconds. patients being therapeutically anticoagulated should have ptts 1 1/2 to 2 times the norm, or 37.5 to 78 seconds. so a ptt of 35 is within normal limits and perfect for allowing a subsequent dose, but 100 would be 4 times the lower end of normal and thus too long, and bleeding could be a problem if the heparin is given. make sense?

i learn so much when i try to explain things to someone else! thanks!!

spiri1, ADN, RN · Dec 30, 2005

Hi Janfrn,

Thank You so very much for clarifying the Heparin's therapeutic value.

I felt relieved that I finally understood:)

I found out today that I passed my NCLEX state boards.

I could hardly relax until I recieved my results.

Now it's time for me to cool out a bit.

Enjoy The New Year Janfrn :smiley_aa

Terri

Pediatric Critical Care Columnist · Dec 31, 2005

:balloons: :biggringi :smiley_aa congratulations!!!!!! woo hoo terri!!!! celebrate today, for tomorrow we work. (or at least i work.)

you're most welcome for the meagre help i gave you. a huge part of my job is explaining things to parents with absolutely no medical knowledge, and it's one of the things i really like about doing what i do. so it's only fair that if i can help another nurse, then i should do it. like i said, i always learn a lot myself when i try to explain something that i "just know". god bless, 2006 is your year!!

jan