High Intensity
These are common indications for treatment with the high intensity heparin drip.
What are venous thrombosis, PE, peripheral arterial embolism and treatment of DIC.
These are common indications for treatment with the low intensity heparin drip.
What are acute coronary syndrome (ACS) or chronic afib
0500, 1300, 2100
What are standard times for AntiXa lab collection?
The time for the next AntiXa lab draw when a patient is started on a heparin drip at 0300.
What is 0700?
Correct patient, correct protocol in use, correct infusion rate, correct bolus dose, correct medication scanned, pump settings match order, pump is locked
What are the components of the 2 RN verification when administering IV heparin?
Formula used to calculate the dose of the initial bolus for the high intensity drip.
What is 80 units / kg?
Formula used to calculate the dose of the initial bolus for the low intensity drip.
What is 60 units / kg
The next AntiXa draw time once 2 consecutive AntiXa levels are target range
What is AntiXa levels may be drawn with AM labs
Mr. Anderson weighs 187 lbs. I use this measurement when calculating the initial bolus dose for a high intensity heparin drip.
What is 85kg?
(187lb / 2.2 lbs/kg = 85 kg)
This device is used to administer the IV heparin infusion when a patient on a heparin drip goes for MRI testing.
What is the MRI compatible IV pump?
8000 units IV
What is the maximum dose of the initial bolus for the high intensity heparin drip?
4,000 units IV
What is the maximum dose of the initial bolus for the low intensity heparin drip?
AntiXa values in this range are close but may still require adjustments.
What is the therapeutic range
Martha weighs 88kg. The initial rate of the low intensity heparin drip will be
11.4 units / kg / hr.
(12 unit/kg/hr * 88kg = 1056 units/hr. This is over the max initial rate of 1000 units/hr. There for the rate needs to be adjusted. 1000units/hr divided by 88kg = 11.4 units/kg/hr)
When entering an order for a bolus or an AntiXa lab draw I should use this order panel in LifeChart.
What is the "Nursing Heparin Protocol Bolus/AntiXa Panel"?
The initial heparin infusion rate and maximum infusion rate for the high intensity protocol.
What is 18 units/kg/hr with a max infusion of 1800 units / hr?
The initial heparin infusion rate and maximum infusion rate for the low intensity protocol.
What is 12 units/kg/hr with a max infusion rate of 1,000 units/hr
This the only row in the algorithm for which there is NO change in the heparin dose.
What is the target level?
The time of the next AntiXa lab check when the AntiXa results as >1 unit/ml and the heparin drip is stopped at 0200.
What is 0400?
RNs use this MAR action when an AntiXa level indicates that no adjustment needs to be made to the heparin infusion rate.
What is "No Rate Change Indicated (high alert med)"
Patients reach this level with a AntiXa lab result of 0.41 to 0.6 units/ml in the high intensity heparin protocol.
What is the target level.
Patients reach this level with a AntiXa lab result of 0.3 to 0.6 units/ml in the low intensity heparin protocol.
What is the therapeutic range?
Deviation from standard draw times occurs when..
What is when heparin infusion drips started/adjusted <4 hours from a standard from a standard lab time
2 hours after the first AntiXa came back > 1 the next AntiXa draw was 0.39. The rate of the high intensity heparin drip should be reduced by this many unit/kg/hour.
What is 4 units/kg/hr.
At SBARP the off-going and on-going nurse review the heparin orders and pump settings. During this review they find the weight in the order and pump is 10kg more than the actual weight of the patient. This is the next action the nurses should take.
What is contacting the provider?
Per the safety concerns listed "once infusion has started, any weight changes to an order should be approved by the provider"
The RN sends heparin infusion details to the infusion pump using pump integration but receives the error message, "unable to match pump library". To troubleshoot the RN performs this action.
What is clear the pump programing to "new patient" and resend details.
(If the pump was previously programmed manually, sending details will result in an error message. When this happens clear the pump completely and start fresh in the pump as if starting with a new patient).
The correct next step for a nurse caring for a patient on an aPTT guideline heparin infusion after a aPTT result has posted.
What is contact the ordering provider so the provider may order any required adjustments to the heparin infusion.
This healthcare team member must order all heparin boluses, rate changes and lab monitoring for patients on aPTT guideline heparin infusion.
What is the ordering provider (NP, MD, PA)
This is the correct protocol for a patient requiring a heparin infusion that has received apixaban in the past 48 hours.
What is the heparin infusion utilizing aPPT guidelines.