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.

References
American Heart Association. (2016). Guide to Anticoagulant Therapy: Heparin.

Retrieved from
http://circ.ahajournals.org/content/103/24/2994/T6.expansion.html
Gillette, M. A., Franck, A., Reeder, D. N., Knott, A., & Frohnapple, D. J. (2015).

Unfractionated heparin anticoagulation using estimated blood volume based

versus weight-based dosing in a Veteran population. American Journal of

dosing
Health-

System Pharmacy, 72S171-S176. Doi :10.2146/sp150027

Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., & Bucher, L. (2014). Medical-

Surgical Nursing: Assessment and Management of Clinical Problems 9th ed. St. Louis:
Elsevier.
Vallerand, A., H., Sanoski, C., A., & Deglin, J. H. (2015). Daviss Drug Guide for

14th ed. Philadelphia: F. A. Davis Company.

Nurses