Heparin Review (activity A)

NDR 445

Student name:----------------------------------------

initiate heparin therapy. Please review the following questions:

0
A patient weighs 154 lb. On admission the patient’s aPTT is 25 seconds. There is an order to

Standard Weight Based Heparin Protocol

For all patients on heparin drips:

1. Weight in KILOGRAMS. Required for order to be processed: ______ kg (Round to nearest whole Kg)

2. Heparin 25,000 Units in 250 mL of 1/2 NS.

4. CBC initially and repeat every __3__ day(s). 25,000

5. Obtain APTT and PT/INR on day one prior to initiation of therapy.
1250
3. APTT every 6h or 6 hours after rate change; every day after two consecutive therapeutic APTTs.

6. Guaiac stool initially, then every day(s) until heparin discontinued. Notify if positive.
7. Neuro checks every _8__ hours while on heparin. Notify physician of any changes.
8. D/C APTT and CBC once heparin drip is discontinued unless otherwise ordered.
100

9. Notify physician of any bleeding problems.

10. Bolus with 80 Units/kg. Start drip at 18 Units/kg/h.

CEREAL

1
11. If APTT is  35 secs: Rebolus with 80 Units/kg and increase rate by 4 Units/kg/h

12. If APTT is 36–44 secs: Rebolus with 40 Units/kg and increase rate by 2 Units/kg/h

13. If APTT is 45–75 secs: Continue current rate

14. If APTT is 76–90 secs: Decrease rate by 2 Units/kg/h

15. If APTT is  90 secs: Hold heparin for 1 hour and decrease rate by 3 Units/kg/h

Io 5158
1. What is the patient’s weight in kilograms (round to the nearest whole number) _ ___ kg?

2. What does the protocol/sample orders indicate for a standard bolus dosage of heparin for this patient

8
_________ units/kg

3. What does the protocol indicate as the required solution concentration (supply dosage) of heparin to

100
use for the bolus? __ _____ units/mL.

TEIGEN

4. Calculate the dosage of heparin that should be administered for the bolus? ______ units

5. Calculate the dose volume of heparin that should be administered for the bolus for this patient

56
_____ _____ mL
6. What does the protocol/sample orders indicate for the initial infusion rate for this patient?

18
_________ units/kg/h t
7. What is the heparin solution volume this patient should receive each hour to provide the correct
infusion for the patient’s weight? ________ mL/h

4184851847

8. According to the protocol/sample orders, how often should the patient’s aPTT be checked? Every

(Activity B)

B- The patient weighs 132 lbs. On admission, the patient’s APTT is 30 seconds. You initiate IV heparin therapy. The IV
pump is capable of delivering infusions using 1 decimal place.

Standard Weight Based Heparin Protocol

For all patients on heparin drips:

1. Weight in KILOGRAMS. Required for order to be processed: ______ kg (Round to nearest whole

Kg)

2. Heparin 25,000 Units in 250 mL of 1/2 NS.

3. APTT every 6h or 6 hours after rate change; every day after two consecutive therapeutic APTTs.

4. CBC initially and repeat every __3__ day(s).

5. Obtain APTT and PT/INR on day one prior to initiation of therapy.

6. Guaiac stool initially, then every day(s) until heparin discontinued. Notify if positive.

7. Neuro checks every _8__ hours while on heparin. Notify physician of any changes.

8. D/C APTT and CBC once heparin drip is discontinued unless otherwise ordered.

9. Notify physician of any bleeding problems.

10. Bolus with 80 Units/kg. Start drip at 18 Units/kg/h.

11. If APTT is  35 secs: Rebolus with 80 Units/kg and increase rate by 4 Units/kg/h

12. If APTT is 36–44 secs: Rebolus with 40 Units/kg and increase rate by 2 Units/kg/h

13. If APTT is 45–75 secs: Continue current rate

14. If APTT is 76–90 secs: Decrease rate by 2 Units/kg/h

15. If APTT is  90 secs: Hold heparin for 1 hour and decrease rate by 3 Units/kg/h

1. What is the patient’s weight in kilograms (round to the nearest whole number) ____ kg? What does

the protocol/sample orders indicate the standard bolus dosage of heparin for this patient?

________________ units/kg

2. What does the protocol indicate as the required solution concentration (supply dosage) of heparin?

____________ units/mL

3. Calculate the dosage of heparin that should be administered for the bolus for this patient

______units, then calculate the dose volume of heparin that should be administered for this patient (round to
the tenths place) _______ mL

4. What does the protocol/sample orders indicate the initial infusion rate for this patient? ________
Units/kg/h

5. The heparin solution volume this patient should receive each hour to provide correct infusion for the
patient’s weight (round to the tenth’s place) _______ mL/h

6. According to the protocol/sample orders, how often should the patient’s APTT be checked?

Every _________ h or __________________________________________________ or

____________________________________________________________

ANSWERS A

1. 154 divided by 2.2= 70 kg

2. Relates to #10 on the posted heparin protocol= 80 units/kg

3. divide 25,000/ 250 mL = 100mL

4. See #10 of the heparin protocol = bolus with 80 units/kg= 80 units x 70 kg= 5600 units

5. The example we reviewed in class lists 1,000 units/mL as the does volume (divide 5600

by 1000= 5.6 mL) ; however, the math calculation quiz does not give this as an option so

you would divide 5600 units by 100 = 56mL

6. See #10 of the protocol for the answer

7. See #10 of protocol; 18 uniuts/kg/hr= 18 x 70= 1260 units/hr; 1260units/hr divided by

100= 12.6 mL/hr

8. See #3 of protocol

ANSWER B-

1. 132 divided by 2.2= 60 kg and standard bolus dosage of heparin= 80 units/kg

2. 25,000 units divided by 250mL= 100 units/mL

3. Bolus= 80 units/kg= 80 x 60= 4800 units and Dose of heparin to be administered= units/ solution

concentration= 4800 divided by 100= 48 mL

4. 18 units/kg/h

5. 18 units/kg= 18 x 60= 1080 units/ 100mL= 10.8 mL/h

6. Every 6 h or 6 hrs after any rate change or daily after 2 consecutive therapeutic APTT’s

The following questions refer to your patient who has orders for IV heparin therapy according to the “Standard Weight

Based Heparin Protocol” noted below. The patient weighs 130 pounds. On admission, the patient’s APTT is 30 seconds.

You initiate IV heparin therapy at 1130 on 06/06/XX. Record your answers in the spaces below. The IV pump is capable

of delivering infusions using 1 decimal place.

Standard Weight Based Heparin Protocol

For all patients on heparin drips:

1. Weight in KILOGRAMS. Required for order to be processed: ______ kg (Round to

nearest whole kg)

2. Heparin 25,000 Units in 250 mL of 1/2 NS.

3. APTT every 8h or 8 hours after rate change; Daily after two consecutive therapeutic

APTTs.

4. CBC initially and repeat every _3_ day(s).

5. Obtain APTT and PT/INR on day one prior to initiation of therapy.

6. Guaiac stool initially, then every day(s) until heparin discontinued. Notify if positive.

7. Neuro checks every 8 hours while on heparin. Notify physician of any changes.

8. D/C APTT and CBC once heparin drip is discontinued unless otherwise ordered.

9. Notify physician of any bleeding problems.

10. Bolus with 70 Units/kg. Start drip at 10 Units/kg/h.

11. If APTT is  35 secs:

12. If APTT is 36–44 secs:

a
Rebolus with 60 Units/kg and increase rate by 4 Units/kg/h
Rebolus with 40 Units/kg and increase rate by 2 Units/kg/h

13. If APTT is 45–75 secs: Continue current rate

14. If APTT is 76–90 secs: Decrease rate by 2 Units/kg/h

15. If APTT is  90 secs: Hold heparin for 1 hour and decrease rate by 3 Units/kg/h

1. What is the patient’s weight as measured in kilograms? (Round to nearest whole kg)_________ kg

What does the protocol/sample orders indicate for the standard bolus dosage of heparin for this patient?

__________ Units/kg

2. What does the protocol indicate for the solution concentration (supply dosage) of heparin? __________

Units/mL

3. Calculate the dosage of heparin that should be administered for the bolus for this patient.__________ Units

then calculate the dose volume of heparin that should be administered for the bolus for this patient (round to

the tenths place).__________ mL

4. What does the protocol/sample orders indicate for the initial infusion rate for this patient?

__________ Units/kg/h

5. The heparin solution volume this patient should receive each hour to provide correct infusion for the patient’s

weight (round to the tenths place).__________ mL/h

6. According to the protocol/sample orders, how often should the patient’s APTT be checked?

Every__________h or _______________________________or ___________________________

ANS

1. 59kg and 70 Units/kg

2. ANS: 100 Units/mL

3. ANS: 4130 Units = 41.3mL

4. ANS: 10 Units/kg

5. ANS: 5.9 mL/h (10x59=590 units/hr divided by 100 units/mL = 5.9 mL/hr)

6. Every 8 h or 8 hrs after any rate change or daily after 2 consecutive therapeutic APTT’s

Provider of Care 5 Team

 Heparin is a naturally occurring product in the body

 Heparin we administer is a synthetic look-alike

◦ Actions: prolong coagulation time, prevent excessive clotting

and to a small degree decreases platelet aggregation

 Unfractionated Heparin

◦ Binds with anti-thrombin III, inhibit action of thrombin and

coagulation factor Xa (FXa)

◦ Rapid-acting anticoagulant…short half-life

◦ Administered by injection only

 IV (Continuous or intermittent)

 Deep Subcutaneous


Stop

fibrin and

stop

clotting

Heparin lack fibrinolytic activity. It

can’t lyse existing thrombi

 Adverse effects

◦ Hemorrhage

◦ Heparin-induced thrombocytopenia

◦ Hypersensitivity reactions

 Contraindicated

◦ Thrombocytopenia

◦ Uncontrollable bleeding

◦ During and immediately after surgery of the eye, brain, or spinal

cord

 Antidote: protamine sulfate

 Activated partial thromboplastin time (aPTT)

 A normal platelet count is between 150,000 and 400,000 per

microliter of blood.

Thrombocytosis

Thrombocytopenia

 Platelets are measured before heparin

 Heparin is stopped typically when the platelet count is

decreased to 50,000 or by 50%

 Activated partial thromboplastin time (aPTT)

 Patients on heparin for DVT for instance need Q6 hours PTTs

 The normal PTT is around 25-35 secs and heparin is effective

when it is 1.5-2.5 times the control

 Hold if > 2.5 times control of platelets are <50% lower than

admit

 May be given concurrently with Coumadin as oral Coumadin

takes 3-5 days to reach peak serum effect

SAMPLE STANDARD WEIGHT-BASED HEPARIN PROTOCOL

For all patients on heparin drips:

1. Weight in KILOGRAMS. Required for order to be processed: kg (round to

nearest whole kg).

2. Heparin 25,000 units in 250 mL of 1/2 N S;

3. aPTT q.6h or 6 hours after rate change; daily after two consecutive therapeutic aPTTs.

4. CBC initially and repeat every 3__ day(s).

5. Obtain aPTT and PT/INR on day one (1) prior to initiation of therapy.

6. Guaiac stool initially, then every day(s) until heparin discontinued. Notify if positive.

7.Neuro checks every 8_hours while on heparin. Notify physician of any changes.

8. Discontinue aPTT and CBC once heparin drip is discontinued unless otherwise

ordered.

9. Notify physician” of any bleeding problems.

10. Bolus with 80 units/kg. Start drip at 18 units/kg/h.

11. If aPTT is less than 35 secs Rebolus with 80 units/kg and increase rate by 4 units/kg/h.

12. If aPTT is 36 to 44 secs: Rebolus with 40 units/kg and increase rate by 2 units/kg/h.

Io
13. If aPTT is 45 to 75 secs: Continue current rate.

14. If aPTT is 76 to 90 secs: Decrease rate by 2 units/kg/h.

5. If aPTT is greater than 90 sec Hold heparin for 1 hour and decrease rate by 3 units/kg/h.

This

The patient weighs 132 lbs. On admission, the patient’s APTT is 30 seconds. You initiate IV heparin

therapy. The IV pump is capable of delivering infusions using 1 decimal place.

1. What is the patient’s weight in kilograms (round to the nearest whole number) 60 kg?

What does the protocol/sample orders indicate the standard bolus dosage of heparin for this

patient? 80 units/kg

2. What does the protocol indicate as the required solution concentration (supply dosage) of

heparin? 100 units/mL

3. Calculate the dosage of heparin that should be administered for the bolus for this patient

4800 units, then calculate the dose volume of heparin that should be administered for this

patient (round to the tenths place) 48 mL

4. What does the protocol/sample orders indicate the initial infusion rate for this patient?

18 Units/kg/h

5. The heparin solution volume this patient should receive each hour to provide correct infusion

for the patient’s weight (round to the tenth’s place) 10.8 mL/h

6. According to the protocol/sample orders, how often should the patient’s APTT be checked?

Every 6 h or 6 hours after rate changes or

Daily after two consecutive therapeutic aPTTS

Refbolus Beblous
Reblous
Rebolas 80 Curly
 incrusrathyy
units
1. 132 divided by 2.2= 60 kg and standard bolus dosage of heparin= 80 units/kg th
Asg

o
2. 25,000 units divided by 250mL= 100 units/mL

3. Bolus= 80 units/kg= 80 x 60= 4800 units and Dose of heparin to be administered= units/
solution concentration= 4800 divided by 100= 48 mL

4. 18 units/kg/h

II
5. 18 units/kg= 18 x 60= 1080 units/ 100mL= 10.8 mL/h

6. Every 6 h or 6 hrs after any rate change or daily after 2 consecutive therapeutic APTT’s
1. What is the patient’s weight in kilograms (round to the nearest
whole number) ____ kg? What does the protocol/sample orders
indicate the standard bolus dosage of heparin for this patient?
____ units/kg
2. What does the protocol indicate as the required solution
concentration (supply dosage) of heparin?_____ units/mL
3. Calculate the dosage of heparin that should be administered for
the bolus for this patient _____ units, then calculate the dose volume
of heparin that should be administered for this patient (round to the
tenths place) ______mL
4. What does the protocol/sample orders indicate the initial
infusion rate for this patient? _____ Units/kg/h
5. What is the heparin solution volume this patient should receive
each hour to provide correct infusion for the patient’s weight (round
to the tenth’s place) _____ mL/h
6. According to the protocol/sample orders, how often should the
patient’s APTT be checked? Every _______ h or__________________ or
________________________
 A patient weighs 154 lb. On admission the
patient’s aPTT is 25 seconds. There is an
order to initiate heparin therapy.
 What is the patient’s weight in kilograms
(round to the nearest whole number) ____ kg?
What does the protocol/sample orders
indicate the standard bolus dosage of
heparin for this patient? ____ units/kg
 What does the protocol indicate as the
required solution concentration (supply
dosage) of heparin?_____ units/mL
 3. Calculate the dosage of heparin that
should be administered for the bolus for this
patient _____ units, then calculate the dose
volume of heparin that should be
administered for this patient (round to the
tenths place) ______mL
 4. What does the protocol/sample orders
indicate the initial infusion rate for this
patient? _____ Units/kg/h
 5. What is the heparin solution volume this
patient should receive each hour to provide
correct infusion for the patient’s weight
(round to the tenth’s place) _____ mL/h
 6. According to the protocol/sample
orders, how often should the patient’s APTT
be checked? Every _______ h
or__________________ or
________________________
1. 70mkg, 80 units/kg
2. 25,000/250 units/ml= 100ml
3. 5600 units, 56mL
4. 18 units/kg/h
5. 12.6 mL/hr
6. Every 6 hour or 6 hours after rate change or daily after 2
consecutive therapeutic PTTs
Thank you for your
listening