Durham VA Medical Center



Durham VA Medical CenterWeight-Based Heparin Nomogram:cardiac protocolObtain Baseline labs: PTT, PT/INR, Hgb/Hct, Platelets, Chem-7, Hepatic enzymesMonitor Platelet count daily Document patient’s weight in kg: ___________Initial Bolus 60 units/kg * Calculations based on(MAX DOSE 4,000 units) actual body weight * Round dose to nearest 100 Initial Infusion Rate 10-14 units/kg/hour units (MAX INITIAL RATE 1,000 units/hr)* Heparin supplied as 25,000 units/250 mL D5WUnits/kg/hourAgeFemaleMaleLess than 60 years121460-79 years111280 years or greater1011Check initial aPTT 6 hours after starting infusion and then after any rate adjustments. After two consecutive therapeutic PTTs, may change aPTT checks to qAM.Adjust heparin rate using the following chart (revised 6/2009): Target aPTT 60-80 aPTT (seconds)Bolus Dose (units)Stop Heparin Infusion (minutes)Rate Change(units/hr)Next aPTT (6 full hrs after dose change)<403,0000↑ 100 units/hr6 hours40-5900↑ 100 units/hr6 hours60-80**00No change6 hrs (if therapeutic x 2, change checks to qAM)81-8500↓ 100 units/hr6 hours86-100030 min↓ 100 units/hr6 hours101-150060 min↓ 200 units/hr6 hours>150060 min↓ 300 units/hr6 hoursNotify MD for any of the following: Decrease in Hgb by more than 2 g/dL, decrease in Plt count by 30% or more from baseline, or counts less than 100,000/mm3, PTT above 101 sec, or signs/symptoms of bleeding or worsening thrombosis. Note: Heparin is a HIGH-ALERT DRUG and needs second verifier.CARDIAC PROTOCOL: Physician enters initial Heparin bolus and infusion orders. Per policy, ICU/ED RN then edits CRPS for rate changes & enters repeat PTT. Poster developed by CCU nursing team spearheaded by Amber Greene, RN. Durham VA Medical CenterWeight-Based Heparin Nomogram:cardiac protocolObtain Baseline labs: PTT, PT/INR, Hgb/Hct, Platelets, Chem-7, Hepatic enzymesMonitor Platelet count daily Document patient’s weight in kg: ___________Initial Bolus 60 units/kg * Calculations based on(MAX DOSE 4,000 units) actual body weight * Round dose to nearest 100 Initial Infusion Rate 10-14 units/kg/hour units (MAX INITIAL RATE 1,000 units/hr)* Heparin supplied as 25,000 units/250 mL D5WUnits/kg/hourAgeFemaleMaleLess than 60 years121460-79 years111280 years or greater1011Check initial aPTT 6 hours after starting infusion and then after any rate adjustments. After two consecutive therapeutic PTTs, may change aPTT checks to qAM.Adjust heparin rate using the following chart (revised 6/2009): Target aPTT 60-80aPTT (seconds)Bolus Dose (units)Stop Heparin Infusion (minutes)Rate Change(units/hr)Next aPTT (6 full hrs after dose change)<403,0000↑ 100 units/hr6 hours40-5900↑ 100 units/hr6 hours60-80**00No change6 hrs (if therapeutic x 2, change checks to qAM)81-8500↓ 100 units/hr6 hours86-100030 min↓ 100 units/hr6 hours101-150060 min↓ 200 units/hr6 hours>150060 min↓ 300 units/hr6 hoursNotify MD for any of the following: Decrease in Hgb by more than 2 g/dL, decrease in Plt count by 30% or more from baseline, or counts less than 100,000/mm3PTT above 101 sec, or signs/symptoms of bleeding or worsening thrombosis. Note: Heparin is a HIGH-ALERT DRUG and needs second verifier.CARDIAC PROTOCOL: Physician enters initial Heparin bolus and infusion orders. Per policy, ICU/ED RN then edits CRPS for rate changes & enters repeat PTT. Poster developed by CCU nursing team spearheaded by Amber Greene, RN.Durham VA Medical CenterWeight-Based Heparin Nomogram:cardiac protocolObtain Baseline labs: PTT, PT/INR, Hgb/Hct, Platelets, Chem-7, Hepatic enzymesMonitor Platelet count daily Document patient’s weight in kg: ___________Initial Bolus 60 units/kg * Calculations based on(MAX DOSE 4,000 units) actual body weight * Round dose to nearest 100 Initial Infusion Rate 10-14 units/kg/hour units (MAX INITIAL RATE 1,000 units/hr)* Heparin supplied as 25,000 units/250 mL D5WUnits/kg/hourAgeFemaleMaleLess than 60 years121460-79 years111280 years or greater1011Check initial aPTT 6 hours after starting infusion and then after any rate adjustments. After two consecutive therapeutic PTTs, may change aPTT checks to qAM.Adjust heparin rate using the following chart (revised 6/2009): Target aPTT 60-80 aPTT (seconds)Bolus Dose (units)Stop Heparin Infusion (minutes)Rate Change(units/hr)Next aPTT (6 full hrs after dose change)<403,0000↑ 100 units/hr6 hours40-5900↑ 100 units/hr6 hours60-80**00No change6 hrs (if therapeutic x 2, change checks to qAM)81-8500↓ 100 units/hr6 hours86-100030 min↓ 100 units/hr6 hours101-150060 min↓ 200 units/hr6 hours>150060 min↓ 300 units/hr6 hoursNotify MD for any of the following: Decrease in Hgb by more than 2 g/dL, decrease in Plt count by 30% or more from baseline, or counts less than 100,000/mm3, PTT above 101 sec, or signs/symptoms of bleeding or worsening thrombosis. Note: Heparin is a HIGH-ALERT DRUG and needs second verifier. CARDIAC PROTOCOL: Physician enters initial Heparin bolus and infusion orders. Per policy, ICU/ED RN then edits CRPS for rate changes & enters repeat PTT. Poster developed by CCU nursing team spearheaded by Amber Greene, RN.Durham VA Medical CenterWeight-Based Heparin Nomogram:cardiac protocolObtain Baseline labs: PTT, PT/INR, Hgb/Hct, Platelets, Chem-7, Hepatic enzymesMonitor Platelet count daily Document patient’s weight in kg: ___________Initial Bolus 60 units/kg * Calculations based on(MAX DOSE 4,000 units) actual body weight * Round dose to nearest 100 Initial Infusion Rate 10-14 units/kg/hour units (MAX INITIAL RATE 1,000 units/hr)* Heparin supplied as 25,000 units/250 mL D5WUnits/kg/hourAgeFemaleMaleLess than 60 years121460-79 years111280 years or greater1011Check initial aPTT 6 hours after starting infusion and then after any rate adjustments. After two consecutive therapeutic PTTs, may change aPTT checks to qAM.Adjust heparin rate using the following chart (revised 6/2009): Target aPTT 60-80 aPTT (seconds)Bolus Dose (units)Stop Heparin Infusion (minutes)Rate Change(units/hr)Next aPTT (6 full hrs after dose change)<403,0000↑ 100 units/hr6 hours40-5900↑ 100 units/hr6 hours60-80**00No change6 hrs (if therapeutic x 2, change checks to qAM)81-8500↓ 100 units/hr6 hours86-100030 min↓ 100 units/hr6 hours101-150060 min↓ 200 units/hr6 hours>150060 min↓ 300 units/hr6 hoursNotify MD for any of the following: Decrease in Hgb by more than 2 g/dL, decrease in Plt count by 30% or more from baseline, or counts less than 100,000/mm3, PTT above 101 sec, or signs/symptoms of bleeding or worsening thrombosis. Note: Heparin is a HIGH-ALERT DRUG and needs second verifier. CARDIAC PROTOCOL: Physician enters initial Heparin bolus and infusion orders. Per policy, ICU/ED RN then edits CRPS for rate changes & enters repeat PTT. Poster developed by CCU nursing team spearheaded by Amber Greene, RN. ................
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