understanding Insulin and Heparin Dosing pls help

joyouter · Feb 6, 2015

Hi - as a new nurse medications can be confusing. Not wanting to preach :cheeky: but You need to review the medications, actions, types of vials and doses and how they are calculated. Try the following below;

When you can sit in a quiet area and Get hold of a tuberculin and insulin syringe. Have another nurse or pharmacy if available. explain the differences as they do look very similar. Handle them, look closely at packaging and at syringe and needle size.

Another point I find helpful is that even if you are using a pen or ad administering this medication via other routes. , always check the vial, name and dosage. There are many similar appearing medications today. So read the label first of all and secondly, have someone check the doses you draw up. Whether it is policy or not.

Read up on heparin and understand how that is given. Heparin does appear in different strengths ie. 1000 iu per ml and for major infusions, I have seen 5000 units per ml. So it is vital that you read the label , know the medications your patient is taking and always be aware that allergies to heparin may occur ( not so often but still possible) Also be aware of the drug interactions.

You raised good points here . Good luck

Esme12, ASN, BSN, RN · Feb 6, 2015

thread moved to the student forum for best response

whofan, ADN, BSN, RN · Feb 7, 2015

you may see different units for heparin, but that is always for a drip and for that, at least at my hospital you have to two nurses to change, or start so you will always have help.

Here.I.Stand, BSN, RN · Feb 7, 2015

I haven't read through all the replies, but in practice NO you never have to convert units to ml for insulin dosing. We use *insulin* syringes which have units marked on them. Also, pharmacies have gone the way of a standard concentration so won't dispense U-100 and U-500. These are safety features because insulin errors can be VERY serious, and we want to eliminate systems errors that can contribute to giving the wrong dose. They don't want math errors to contribute to insulin errors.

Standardized concentrations of high-risk drugs is actually a Joint Commission rec.

Where math is involved is if the Rx is for a certain number of units per carb choice at each meal. In that case, you just multiply the Rx'ed number of units by the number of carbs...and then draw up the appropriate number of units. You're still not going to have to figure out how many mL of insulin.

Heparin, likewise is a high-risk drug, and hospitals are standardizing their concentrations. We have vials of 5000 units/0.5 mL, prefilled syringes of 100 units/mL for line flushes, and bags of 100 units/mL for IV infusion. (although the pharmacy can mix a more concentrated bag for IV infusion, if fluid overload is an issue for the patient. But that's a non-standard concentration and will be labeled with a big ol' fluorescent red sticker that said "NON-STANDARD CONCENTRATION.")

For your heparin question, they are all the Rx'd number of units. I'd pick the highest concentration so that you're injecting the smallest amount of fluid SQ. But in practice, it's going to be 5000 units/0.5 mL because that's what's going to be available.

Here.I.Stand, BSN, RN · Feb 7, 2015

Wait, I just saw in your profile you're in Australia. I'd ask your instructor if Australian hospitals have any safety policies for high-risk drugs similar to what I described. If not, then I would ALWAYS, ALWAYS, ALWAYS double-check my math, and then have a 2nd RN check it with me.

In your example, you did the D/H formula correctly, so I'm assuming you understand how to do the conversion. But hopefully you don't have to do it in practice.

CT Pixie, BSN, RN · Feb 7, 2015

Double checking insulin is not 'gospel' in either of the hosptials I work at. Of course, you can always have another RN double check but it isn't required. As well, the SNF I worked in did not require a co-signer/double check nurse either. I think that policy varies in every facility.

suga_junkie, BSN, RN · Feb 7, 2015

I'm in Australia. You will not have to calculate insulin doses, it will always be prescribed in units. Insulin is always given in an insulin syringe. It would specify on the prescription if the insulin were to be stronger than u100 and still reflect the total dosage in units. Heparin 5000 units for subcutaneous injections only comes in 0.2ml as far as I'm aware so no calcs required there either.

ETA: insulin has to be signed off by 2 nurses in my hospital.

maria48 · Feb 7, 2015

Thanks for all the clarifications. I am researching all common calculation that they do in the ward (Medical Ward setting) like reconstitution, insulin, IV drips, I am still learning but this thread is really helping me transition into the real world in nursing not just in class. Thanks

myrachandler · Feb 7, 2015

Insulin pens are in units; you'll also draw up Insulin from vials with Insulin syringes which are also marked in Units. I will defer the Heparin question to others because I have not dealt with Heparin for years.

Both Insulin and Heparin were considered "high alert" medications where I worked, so two Nurses had to check doses and sign-off. I think this is a good idea.

Keep asking questions! That's a sign of a conscientious Nurse. Talk to your Instructor about these two questions, read everything you can find on Insulin and Heparin, and make yourself an expert (at least knowledge-wise--you'll learn the skills). It will help with your nerves, which are normal. I still use a Clinical Nursing book to look-up/refresh my knowledge. I still look up medications whenever I am unsure. I still look up questions I have about A&P or Diseases/conditions. That was my biggest take-away from Nursing school. Don't do anything if you're not sure--ask for help. Good Luck!

nurseprnRN, BSN, RN · Feb 7, 2015

As an aside, I have never understood why some experienced folks get so anxious about having another RN check their insulin. I'll bet they give a lot of other things in syringes that are a lot more dangerous if mis-dosed, and nobody has an age-old tradition of checking them.

I think this goes back to the day when insulin was first available and so scary and high-tech that only physicians could give it. Then as it got more used, docs got tired of giving injections all the time, but the fear remained that a mere nurse might make an error with it, so the mandate was for it to be checked. And then ... see "Monkeys and ice water https://allnurses.com/nurse-colleague-patient/because-thats-the-846662.html."

OD somebody on digoxin or gentamycin and you've got real troubles on your hands. OD him on insulin and it's, "Hey, get the D50, and don't do it again."

imintrouble, BSN, RN · Feb 7, 2015

As an aside, I have never understood why some experienced folks get so anxious about having another RN check their insulin. I'll bet they give a lot of other things in syringes that are a lot more dangerous if mis-dosed, and nobody has an age-old tradition of checking them.

I think this goes back to the day when insulin was first available and so scary and high-tech that only physicians could give it. Then as it got more used, docs got tired of giving injections all the time, but the fear remained that a mere nurse might make an error with it, so the mandate was for it to be checked. And then ... see "Monkeys and ice water https://allnurses.com/nurse-colleague-patient/because-thats-the-846662.html."

OD somebody on digoxin or gentamycin and you've got real troubles on your hands. OD him on insulin and it's, "Hey, get the D50, and don't do it again."

I think the reason I stress on insulin is there are 4-5 different vials in the fridge at any given time. We draw up from those vials. No individual supply. At least two of them look exactly the same except for the writing.

I saw the aftermath of a nurse who gave 50 units of R instead of 50 units of 70/30.

You're right, D50 and some IVF fixed it right up, but the nurse was seriously shaken.

I always hunt down another nurse and double check.

I didn't know about the MD thing and insulin until you posted.

I can't imagine that happening now with any drug.

Susie2310 · Feb 8, 2015

As an aside, I have never understood why some experienced folks get so anxious about having another RN check their insulin. I'll bet they give a lot of other things in syringes that are a lot more dangerous if mis-dosed, and nobody has an age-old tradition of checking them.

I think this goes back to the day when insulin was first available and so scary and high-tech that only physicians could give it. Then as it got more used, docs got tired of giving injections all the time, but the fear remained that a mere nurse might make an error with it, so the mandate was for it to be checked. And then ... see "Monkeys and ice water https://allnurses.com/nurse-colleague-patient/because-thats-the-846662.html."

OD somebody on digoxin or gentamycin and you've got real troubles on your hands. OD him on insulin and it's, "Hey, get the D50, and don't do it again."

Being overdosed on insulin can have very serious or even fatal consequences for a patient, especially if the patient has other significant medical problems, if the error is not caught and remedied very quickly. I have no problem with having been taught to double check insulin with another nurse if it helps me to prevent an error in administration, thereby sparing a patient from the burden of receiving additional treatment that would not ordinarily have been necessary, or if it helps prevent serious patient injury or death.