Heparin Drip - Portfolio

Heparin Drip Administration
PROTOCOL POLICY
PRESENTED BY:
OLGA GUTIERREZ
LANA KUKSGAUZEN
MARY REESE
CATHRYN REID
Indications
Venous Thromboembolism
Pulmonary Emboli
A-fib with embolization
Peripheral Arterial Thromboembolism
Acute Coronary Syndrome
Acute Ischemic Attack
Action
Prevents formation of blood clots and ceases
progression of pre-existing clots.

IV Continuous:
Onset: immediate
Peak: 5-10minutes
Duration: 2-6 hrs.
Nursing implications
Obtain patients weight prior to initiation of therapy
Obtain aPTT, PT, CBC prior to initiation of therapy
Obtain baseline VS prior to initiation of therapy
Administer heparin infusion per MD order
An infusion pump must be used to
ensure proper IV flow rate
Nursing interventions during infusion

Blood draw to monitor aPTT values per agency policy
Adjust infusion per agency policy
Assess IV site
Monitor vital signs q4hr & prn
Monitor for s/s of bleeding
Maintain Bleeding precautions
Monitor CBC
Ensure antidote (Protamine Sulfate) is available
Expected Outcomes
Existing thrombi do not enlarge
New thrombi do not form
Heparin does not dissolve the existing clots
Patient is free of unusual bleeding
aPTT is within therapeutic range
(55 80 at ACH)
Complications
Spontaneous bleeding
Existing thrombi enlarges
New thrombus forms
PE
CVA
HIT = heparin induced thrombocytopenia
An
immune reaction to heparin causing a severe, sudden
decrease in platelet count along with a paradoxical
increase in venous or arterial thrombosis
Evidence Based Practice

The Joint Commissions National Patient Safety
Goals for 2016 include:

NPSG.03.05.01 - Reduce the likelihood of patient
harm associated with the use of anticoagulant
therapy.
While TJC recommends that approved protocols be
used for initiation and maintenance of anticoagulant

therapies, no specific method is mandated for
calculating initial dose and dose adjustments.
Evidence Based Practice

AMH and Upstate both use weight based dosing
BUT
EBP shows that estimated blood volume dosing
may:
Achieve therapeutic PTT levels quicker
Result in less bleeding
However, since this was a limited study, you may still
see weight based dosing in practice. But stay tuned
in the future for possible changes to heparin drip
administration to estimated blood volume dosing.
Case Study
Mrs. Hanson, age 72, weight 59 kg, sustained
multiple bruises and a concussion in an automobile

accident. She has cardiac dysrhythmia and was
admitted 2 days ago for observation and
recuperation. She has now developed pain in her
right calf, and her lower leg is swollen, with a hot
tender area in the mid-calf region. She has been
placed on a continuous heparin drip. You are the
nurse assigned to care for this patient.
Case Study
The pts initial aPTT is drawn, and based on this and
the pts wt, the doctor orders the heparin drip to run
at:
18 Units/kg/hr x 59 kg = 1 062 1 050 Units/hr
Case Study
Question 1: How should you administer the heparin
via pump or gravity?
Case Study
Question 1: How should you administer the heparin
via pump or gravity?

Answer: via pump
Rationale: Accuracy of heparin infusion is critical
Case Study
Question 2: While the heparin drip is running, what
assessments do you make on the patient?
Case Study
Question 2: While the heparin drip is running, what
assessments do you make on the patient?

Answer: S&S bleeding, SOB, change in LOC, cxpn,
feeling of doom (S&S PE)
Case Study
Question 3: Its been 6 hours, you redraw the blood
for the PTT which is 45. What do you do with the

heparin drip?
Case Study
Question 3: Its been 6 hours, you redraw the blood for the
PTT which is 45. What do you do with the heparin drip?

Answer: The PTT is too low which means the time it takes
for a clot to form is too short so the pt is clotting too much

Therefore we need to increase the heparin.
Use the Heparin Infusion Calculation work sheet, and adjust
the rate based on the pts weight and the aPTT value.
Document!
At AMH, this is done in the pts paper chart in pts binder
Case Study
Question 4: Its now the end of your shift and you are
going to give your shift-to-shift report on this

patient. What do you need to communicate to the
next nurse about this patient?
Case Study
Question 4: Its now the end of your shift and you are
going to give your shift-to-shift report on this

patient. What do you need to communicate to the
next nurse about this patient?
Answer: Current rate of heparin drip, what time the
PTT is to be drawn, what you did with the heparin

drip on your shift, pts current labs for: PTT,
platelets; pt assessments done in question #2
Case Study
New bolus dose
40 Units/kg x 59 kg = 2360 2500 Units
We have vial of Heparin 5000 Units/ml
2500 Units x 1ml/5000 Units = 0.5 ml
Our new rate of infusion
18 Units/kg/hr + 2 Units/kg/hr = 20 Units/kg/hr
20 Units/kg/hr x 59 kg = 1180 1200 Units/hr

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Heparin Drip Administration

progression of pre-existing clots.

ensure proper IV flow rate

Nursing interventions during infusion

Evidence Based Practice

Goals for 2016 include:

used for initiation and maintenance of anticoagulant

Evidence Based Practice

multiple bruises and a concussion in an automobile

The pts initial aPTT is drawn, and based on this and

via pump or gravity?

via pump or gravity?

assessments do you make on the patient?

assessments do you make on the patient?

feeling of doom (S&S PE)

for the PTT which is 45. What do you do with the

PTT which is 45. What do you do with the heparin drip?

for a clot to form is too short so the pt is clotting too much

going to give your shift-to-shift report on this

going to give your shift-to-shift report on this

PTT is to be drawn, what you did with the heparin

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