General Knowledge
Heparin is used for the treatment of
DVT, A-fib, PE, MI
When two nurses verify an order, medication, and rate this is called
Double verification
This lab is drawn 6 hours after the initiation of a heparin infusion and change in infusion rate
PTT
This is the most serious adverse effect of heparin
Heparin-induced thrombocytopenia (HIT)
The patient's heparin drip is currently infusing at 18 units/kg/hour. The PTT level has just resulted and is 0.62. Using the heparin protocol, what is the next action that needs to be initiated?
Order a PTT for six hours from now, this is a therapeutic PTT.
How many orders will you potentially as part of a heparin drip?
Three: the loading dose, the drip, and PRN bolus doses.
These are the steps of an independent double check
Two licensed nurses verify the correct medication therapy based on physician orders, labs, and weight. The first nurse calculates the dose and prepares the pump independently. Then the second nurse also calculates the dose and checks the pump independently with no input from the other nurse.
After two consecutive therapeutic results, the frequency for PTT draws can be changed to
Daily
This lab value should be monitored daily to look for HIT
Platelets
You receive an order to start a heparin drip. What do you need to do before you start the infusion?
Weight the patient and get a PTT, make sure the patient has a patent IV
Heparin can be administered via these routes
IV and Sub-q
An Independent double check is completed at this point during heparin administration
When initiating a heparin drip, hanging a new bag, and when changing the rate
The dosage of heparin is considered adequate when the whole blood clotting time is approximately ___ times the control value
1.5- 2.5
Name three side effects you will educate your patient to notify you of
Bleeding from gums, hematuria, bruising
The patient's heparin drip is currently infusing at 15 units/kg/hour. The PTT level has just resulted and is 0.32. Using the heparin protocol, what are the next two actions that need to be initiated?
Administer a heparin bolus of 2500 units, then increase the pump by 2 units.
True or false: a bolus/loading dose is always administered prior to beginning a heparin drip?
False
Standard heparin dosing protocols utilize weight-based dosing using the patient's weight in kilograms. What is the base dosing formula you should be prepared to enter when you initiate heparin therapy for BHN?
18 units/kg/hr
The therapeutic range for heparin is
60-75
You are reviewing your labs in the morning and see that the patient's platelets have dropped from 120 to 90. Your patient is complaining of pain to the left arm and upon assessment, it is red and swollen. What do you do next?
Notify the physician, this patient may have HIT.
The lab called and said there isn't enough sample in the tube to do a PTT. What do you do next?
Notify the PCA to re-draw the lab ASAP, since this is a timed study.
The antidote for heparin is
Protamine sulfate
Your co-worker has asked you to verify a rate change for the heparin drip and says it should be increased by 4 mL. What do you do next?
Re-calculate according to UNITS. The BHN heparin protocol does not adjust by mL, but by units.
These two measurements are needed prior to beginning a heparin drip
Dosing weight in kilograms and PTT
You walk into your patient's room who is on a heparin drip and find the patient to have significant sanginous output in the chest tube. After shutting off the heparin drip what medication do you expect the physician to order?
What is protamine sulfate
The patient's heparin drip is currently infusing at 22 units/kg/hour. The PTT level has just resulted and is 1.59. Using the heparin protocol, what should you do next?
Stop the pump for one hour, then decrease by 3 units.