The potency is determined by a biological assay using a usp reference standard based on units of heparin activity per milligram. Ptt 6 hours after every bolus dose, after a dose adjustment, and after the first no change desired range result. This page contains clinical practice guidelines for the administration of standard heparin infusions, systemic lytic therapy and the management of a blocked central venous access device. Identify commonly used treatments, identified by standards of care, for patients. These changes warranted reevaluation of the standard and lowertarget protocols. Fifty consecutive patients with acute venous thromboembolism had their continuous. Easily remember spectrum of activity with my free visual critical care antibiotic guide. Intravenous high intensity heparin nomogram venous thromboembolism dvt pe hch2282 eff. Implement weightbased heparin protocols selecting heparin doses based on weight has been found to provide partial thromboplastin time ptt results that are more likely to be within the desired therapeutic range and to fluctuate less when doses are adjusted.
It is not a substitute for appropriate clinical evaluation and does not supersede clinical judgment. The effectiveness of an existing nonweightbased heparin nomogram in achieving a therapeutic aptt was compared sequentially with that of a weightbased heparin nomogram in 89 and 84 consecutive. Fifty consecutive patients with acute venous thromboembolism had. Argatroban is a direct thrombin inhibitor used in the treatment of heparin. Issuu is a digital publishing platform that makes it simple to publish magazines, catalogs, newspapers, books, and more online. Identify factors andor comorbidities affecting andor contributing to perfusion. See part b of weight based heparin order form initial infusion rate dependent on specific indication 10,000 5005,000250 250 380380 if at 6 hours, ptt is still greater than 120, hold heparin and call physician immediately for further orders. The study looked at a retrospective cohort of patients who received heparin before and after the implementation of a heparin protocol using adjusted. Weightbased heparin protocol using antifactor xa monitoring. Heparin infusion algorithms anticoagulation services. Data on demographic characteristics of patients, heparin therapy, laboratory monitoring, conversion to warfarin therapy, and protocol management were collected for the patients receiving heparin under the revised protocol. In 1996, a weightbased protocol for administration of heparin was implemented and assessed at the authors institution.
Unfractionated heparin ufh and lowmolecular weight heparin lmwh are highly utilized throughout inpatient and ambulatory care settings for many indications, including the treatment of venous thromboembolism, thromboprophylaxis, and acute coronary syndromes. Evaluation of current heparin weight based protocol in. Weight based heparin dosing for thromboembolic disease is. Heparin infusion guidelines anticoagulation services. Clair hospital in pittsburgh, pennsylvania, swiftly mobilized and seized the opportunity to improve. Develop a different weightbased protocol for patients receiving thrombolytics or. Evaluation of 2 weightbased protocols for administration.
Internal audits to determine the dose requirement to produce therapeutic anticoagulation based. Evaluation of an unfractionated heparin pharmacy dosing protocol. Unfractionated heparin and low molecular weight heparin. Medication safety using automated heparin protocols and cpoe to reduce errors by amy stablein georgulis, pharmd, and sabina daroski, mdwhen the joint commission adopted a national patient safety goal requiring hospitals to reduce the likelihood of patient harm from the use of anticoagulants, st. The performance of a weightbased dosing protocol for unfractionated heparin ufh infusions using antifactor xa monitoring was evaluated. Argatroban order set for heparininduced thrombocytopenia hit. The prolongation of the clotting time that results from the heparin in the patients plasma is compared with pooled normal plasma that is known to be free of heparin. Order as needed rebolus for subtherapeutic antixa, if warranted. Weight based argatroban dosing nomogram for treatment of heparin induced thrombocytopenia. Therefore, it is appropriate to use abw in a weight based heparin dosing protocol for this. Unfractionated heparin ufh and low molecular weight heparins lmwh are parenteral anticoagulants commonly used to prevent and treat thromboembolism. Idarucizumab praxbind low molecular weight heparins lmwh general dosing guidelines.
Heparin infusion guidelines university medical center. Select the dose adjustment nomogram based on indication for ufh use 1. Volume 12, issue 12, december 2014, pages 14161419. Adult heparin drip protocol this protocol reflects current evidence based clinical practice. Adult unfractionated heparin infusion protocol objective.
Adult heparin infusion protocol this protocol reflects current evidence based clinical practice. A nomogram for the adjustment of heparin dosage was developed to standardize heparin therapy and to reduce delays in achieving and maintaining a therapeutic activated partial thromboplastin time aptt result. A revised protocol for heparin therapy, in which dosing was based on the patients weight and the pharmacy staff assumed responsibility for management of the. A weightbased ufh dosing nomogram using antifactor xa monitoring resulted in a high percentage of patients achieving target antifactor xa values within the first 24 hours of therapy.
Implementation of a lowmolecularweight heparin risk based protocol for postpartum thromboembolism prevention resulted in high physician adherence and more than 30% of. Easily share your publications and get them in front of issuus. I heard of a hospital near me that is switching to this, due to excessive errors being made by nurses using the traditional, weight based protocol. Heparin therapeutic unfractionated heparin ufh infusion. Allergy to heparin discontinue the following iv, sq or po anticoagulants except heparin flushes. Therapeutic dosing of unfractionated heparin adult emergency. This video explains what is happening during the administration of heparin as a bolus and iv drip. Order standard heparin infusion with starting rate defaulted based on indication. Prior to 2016, heparin dosing was based on standard care nomogram. Discontinue any orders for low molecular weight heparin lmwh lovenox, arixtra, fragmin, or subcutaneous unfractionated heparin. Results were compared with those obtained for the old, fixeddose protocol, which was managed by nursing staff. May 22, 2010 medication safety using automated heparin protocols and cpoe to reduce errors by amy stablein georgulis, pharmd, and sabina daroski, mdwhen the joint commission adopted a national patient safety goal requiring hospitals to reduce the likelihood of patient harm from the use of anticoagulants, st. Unfractionated heparin infusion protocol objective. The standard concentration for heparin is 25,000 units250 ml d5w heparin doses should be rounded to the nearest 100 unitshr increment monitoring.
Such factor xabased heparin assays usually employ purified factor xa as a reagent and factor xdeficient substrate plasma as the source of antithrombin. Based on 17,572 records submitted to medmarx during the period jan. Evaluation of 2 weightbased protocols for administration of. Heparin considerations for use american college of. Overlap warfarin with heparin for at least 5 days and until the inr is within the therapeutic range for 2. Adult patients requiring iv unfractionated heparin anticoagulation therapy. Heparin also prevents the formation of a stable fibrin clot by inhibiting the activation of the fibrin stabilizing factor. The effectiveness of an existing non weight based heparin nomogram in achieving a therapeutic aptt was compared sequentially with that of a weight based heparin nomogram in 89 and 84 consecutive. Dec 17, 2014 this video explains what is happening during the administration of heparin as a bolus and iv drip.
In addition, the clinical haematology department has developed guidelines to support clinicians management of warfarin and low molecular weight heparin clexane. Heparin protocols are standardized procedures personnel at a hospital or clinic follow when they administer heparin to reduce the chance of errors. Baseline labs prior to administering heparin products within previous 48 hrs ptt and auto diff. Continue heparin until inr is within therapeutic range for at least 2 days.
Outcomes associated with a heparinfree hemodialysis protocol. Selective and continuous transarterial heparin infusion. Use preservative free heparin sodium injection in neonates and infants. Reference guide for weightbased heparin dosing heparin concentration heparin concentration. All heparin infusions use the standard preparation of heparin 25,000 units in 250 ml of d5w 100 unitsml contraindication. Nomogram for dvtpe, the infusion dose should be increased by 2. Epocrates products are compatible with palm os and pocket pc pdas, and with windows and macintosh computers. When using a full dose heparin regimen, adjust the heparin dose based on frequent blood coagulation tests. Therapeutic dosing of unfractionated heparin adult emergency departmentinpatient clinical practice guideline. Reference guide for weight based heparin dosing heparin concentration heparin concentration for bolus dose 5,000 unitsml for infusion 25,000 units in 250ml 0. The extra vasculature present in obese patients appears to have minimal effect on the dosing of heparin. A heparin bolus of 2500 units and infusion of 10 unitskghr into the circuit are used for patients who have a low bleeding risk and meet the following criteria. How do i calculate the appropriate dosage to administer to a patient when i am given a. Baseline labs such as ptt should not be used for infusion rate adjustments per nomogram.
Anticoagulation therapy this page contains clinical practice guidelines for the administration of standard heparin infusions, systemic lytic therapy and the management of a blocked central venous access device. The first 50 patients to receive a ufh infusion per the. It has been recognized in the literature that patients in whom heparin infusion therapy is dosed according to weight based nomograms achieve earlier therapeutic range, shorter length. Adult heparin drip protocol dept of medicine 070214 executive committee 081214 this protocol reflects current evidence based clinical practice. Then, depending on the patients gender, indication for heparin, and route of heparin administration, the nurse selected one of these eight variations. Is anyone familiar with anything in the literature reg. Fractionated, low molecular weight heparin lmwh sc administration. It is to be administered by intravenous or deep subcutaneous routes. Notify physician if platelet count is less than 100 k, hemoglobin drops by more than 1 gram from baseline, or other abnormal values. Protocols and policies national patient safety goal 3e requires that each patient prescribed warfarin, heparin, or low molecular weight heparin have individualized treatment, management, and education. Heparin dosage calculations using a protocol dan ozimek.
The performance of a weight based dosing protocol for unfractionated heparin ufh infusions using antifactor xa monitoring was evaluated. A heparin based protocol for anticoagulation during crrt has been published in the open access journal critical care. The leading provider of handheld and web based clinical reference tools, helping healthcare professionals avoid medication errors and practice more efficiently. Heparin sodium injection, usp is a sterile solution of heparin sodium derived from porcine intestinal mucosa, standardized for anticoagulant activity. Nurse to adjust heparin dosing based on continuous lab monitoring and scale. Subscribe on itunes, android, or stitcher according to the ashp current drug shortages list, both calcium chloride and calcium gluconate are in short supply due to manufacturing delays. To standardize heparin anticoagulation therapy at university hospital. Clair hospital in pittsburgh, pennsylvania, swiftly mobilized and seized the. Heparin is a potent anticoagulant medication, and a patient could become very ill if care providers make a mistake. Heparin overview1 heparin is a glycosaminoglycan which inhibits the mechanism that induces the clotting of blood and the formation of stable fibrin. For administration guidelines please refer to the liverpool hospital guideline by right clicking on the hyperlink. An audit at mercy gilbert medical center and chandler regional medical. The authors make no claims of the accuracy of the information contained herein. Article information, pdf download for evaluation of an unfractionated heparin pharmacy dosing.
Weightbased heparin dosing can lead to exceptionally high initial heparin doses in obese patients. Exemplars used this week are htn, cad, and acute mi 1. A standard heparin nomogram for the management of heparin therapy. Since then, several modifications have been made, including introduction of a lowertarget protocol. Evaluation of 2 weightbased protocols for administration of heparin. Iv heparin is a high risk medication and has been linked to serious adverse patient outcomes. Unfractionated heparin infusion protocol hospital quality institute. Protocols create a simple, clear guideline for how to handle this medication and. Apr 12, 2020 a weight based ufh dosing nomogram using antifactor xa monitoring resulted in a high percentage of patients achieving target antifactor xa values within the first 24 hours of therapy. Heparin dosage calculations using a protocol youtube.
Is anyone here using a nonweight based heparin protocol for dosing patients on heparin drips. The local anticoagulation method of using citrate during. How do i calculate the appropriate dosage to administer to a patient when i am given a heparin protocol. Parallel plate or coil dialyzers were used in some of the earliest trials, as were dialyzers with smaller surface areas and nonsynthetic, cellulosicbased dialyzers 4. Drug guideline heparin nsw agency for clinical innovation.
Uw medicine heparin infusion ultra low intensity algorithm 2019. Current data on the optimal heparin dosing in obese patients. In the older version, the nurse accessed a computer menu of eight variations of the heparin protocol. Your patient is currently receiving an infusion based on 18unitskghour. Initiate warfarin when appropriate usually start on same day as heparin. Then, depending on the patients gender, indication for heparin, and route of heparin administration. Heparin anticoagulation for crrt continuous renal replacement therapy. Intravenous high intensity heparin nomogram venous. In this episode, ill discuss alternative anticoagulation strategies for continuous renal replacement therapy during the calcium shortage.
Baseline labs ptinr aptt cbc monitoring while on heparin antixa level 6 hours after starting the infusion and 6 hours after each change in the infusion rate. Guidance for the practical management of the heparin ncbi. Special notes monitor aptt, hemoglobin, hematocrit, platelets, stool for occult blood based on hospitals nomogram. A standard heparin nomogram for the management of heparin. It has been recognized in the literature that patients in whom heparin infusion therapy is dosed according to weight based nomograms achieve earlier therapeutic range, shorter length of stay, and fewer. It has been recognized in the literature that patients in whom heparin infusion therapy is dosed according to weightbased nomograms achieve earlier therapeutic range, shorter length of. Therapeutic dosing of unfractionated heparin adult. Your patient has a dvt is ordered for a heparin infusion to start at 18 unitskghour. Implement weight based heparin protocols page content selecting heparin doses based on weight has been found to provide partial thromboplastin time ptt results that are more likely to be within the desired therapeutic range and to fluctuate less when doses are adjusted. Weight based heparin orders for deep venous thrombosis dvt and pulmonary embolism pe obtain ptt, inr, cbc prior to initiating heparin.
College lab week 1 objectives unit i perfusionrelated to alterations in perfusion weekly course objectives. Review of incidents revealed the importance of documenting the clinical indication for iv heparin, using the appropriate iv heparin protocol and documenting the actions related to the infusion i. Do not start in patients who have had tpa, for ischemic stroke, within 24 hours. If the coagulation test is unduly prolonged or if hemorrhage occurs, discontinue heparin promptly see overdosage 10. Argatroban order set for heparininduced thrombocytopenia hit atn. Unfractionated heparin and lowmolecularweight heparin. Implement weightbased heparin protocols ihi institute. Removal of recommendations for heparin monitoring and dose titrations using ptt key practice recommendations 1. Mar 15, 2020 heparin protocols are standardized procedures personnel at a hospital or clinic follow when they administer heparin to reduce the chance of errors. It has been recognized in the literature that patients in whom heparin infusion therapy is dosed according to weightbased nomograms achieve earlier therapeutic range, shorter length. Discontinue all other orders for heparin products i. Start the infusion at 2mlshour 1,000 unitshour check aptt ratioaptt sec 4. Evaluation of current heparin weight based protocol in obese. Start the infusion at 2mlshour 1,000 unitshour check aptt ratioaptt sec 4 hours after infusion start.
Weight based heparin dosing for thromboembolic disease is associated with earlier anticoagulation in surgical patients. Pdf implementation of a riskbased heparin protocol for. Apr 11, 2020 the extra vasculature present in obese patients appears to have minimal effect on the dosing of heparin. Small amounts of heparin inhibit factor xa, and larger amounts inhibit thrombin factor iia. Unfractionated heparin ufh and lowmolecularweight heparin lmwh are highly utilized throughout inpatient and ambulatory care settings for many indications, including the treatment of venous thromboembolism, thromboprophylaxis, and acute coronary syndromes.
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