|
|
| Line 1: |
Line 1: |
| − | WEIGHT-BASED HEPARIN GUIDELINES from [http://mycourses.med.harvard.edu/ec_res/nt/D98163D6-9BA9-48B2-9994-9F5F5518636C/heparin.doc Beth Israel Deaconess Medical Center compliments of John Halamka]
| + | #REDIRECT [[CDS]] |
| − | (Order Supplement)
| + | |
| − |
| + | |
| − | '''''Should Not Be Used For Patients With Abnormal Baseline PTT'''''
| + | |
| − | | + | |
| − | 1. Obtain baseline PTT, platelet count and CBC.
| + | |
| − | | + | |
| − | 2. If starting a new infusion for venous thromboembolism, or for arterial thromboembolism other than acute coronary syndromes:
| + | |
| − | * Give an initial bolus of 80 units/kg
| + | |
| − | * Start the infusion at an initial rate of 18 units/kg
| + | |
| − | | + | |
| − | 3. If starting a new infusion for acute coronary syndromes:
| + | |
| − | * Give an initial bolus of 60 units/kg, maximum 4,000 units
| + | |
| − | * Start the infusion at an initial rate of 12 units/kg
| + | |
| − | | + | |
| − | 4. If starting a new infusion for stroke:
| + | |
| − | * No initial bolus
| + | |
| − | * Start the infusion at an initial rate of 13 units/kg
| + | |
| − | | + | |
| − | 5. If patient is currently on low molecular weight heparin, give the first IV heparin dose 8 hours after the last dose of low molecular weight heparin.
| + | |
| − | | + | |
| − | 6. Check PTT and adjust according to sliding scale with the following frequency:
| + | |
| − | * After infusion is begun, check PTT every 6 hours.
| + | |
| − | * After any dose change, check PTT every 6 hours.
| + | |
| − | * When PTT is therapeutic for two consecutive tests, check PTT once daily.
| + | |
| − | | + | |
| − | 7. Adjust heparin infusion according to the following sliding scale:
| + | |
| − | | + | |
| − | 8. Notify house officer if signs of bleeding occur.
| + | |
| − | | + | |
| − | This is a general guideline and does not represent a professional standard of care governing providers' obligations to patients. Care is revised to meet individual patient needs.
| + | |
| − | | + | |
| − | <table style="background-color: FFFFFF;" border="4">
| + | |
| − | <th align=center>Heparin Dosing Guidelines</th>
| + | |
| − | <tr><td align=center>PTT (sec)</td> <td>Bolus (units/kg)</td> <td>Hold (min)</td> <td>Rate Change (units/kg/hr)</td><tr>
| + | |
| − | <tr><td align=center>Under 40</td> <td>40</td> <td>-</td> <td>Increase infusion rate by 4</td><tr>
| + | |
| − | <tr><td align=center>41 - 60</td> <td>20</td> <td>-</td> <td>Increase infusion rate by 2 </td><tr>
| + | |
| − | <tr><td align=center>'''60 - 100'''</td> <td>- </td> <td>-</td> <td>No change</td><tr>
| + | |
| − | <tr><td align=center>101 - 120</td> <td>-</td> <td>-</td> <td>Reduce infusion rate by 2 </td><tr>
| + | |
| − | <tr><td align=center>Over 120</td> <td>-</td> <td>60</td> <td>Reduce infusion rate by 4 </td><tr>
| + | |
