VALLEY BAPTIST MEDICAL CENTER

HARLINGEN, TEXAS

Heparin Treatment Protocol

(Weight-Based)

PHYSICIAN ORDERS

HEPARIN WEIGHT-BASED TREATMENT PROTOCOL (check one)

 Standard Protocol (DVT or PE or ACS without thrombolytic or GP IIb/IIIa use)
 Modified Protocol (Acute Coronary Syndrome: ST or Non ST Segment MI with use of thrombolytics or GP IIb/IIIa)

Nursing to Complete: Patient Wt: ________________ lbs _______________ kg

Dosage Calculations based on actual body weight.

(round to nearest weight in dosing table i.e. if halfway or more to next weight round up, if less than halfway round down)
1. Heparin 25,000 units in 250 mL (100 units/mL) of ½ NS
2. Initial IV LOADING DOSE See scale below and table on back.
3. Initial IV INFUSION RATE See scale below & table on back.
4. WARFARIN will be started:  No  Yes at ________ mg P.O. daily, to start on second day of heparin.
5. LABS: CBC with platelets now & every 3 days beginning in a.m. PTT now and treat according to scale below.
Pro time daily only if Warfarin started.
6. ADJUST heparin infusion based on sliding scale below: Target PTT = 71 – 123 seconds

Heparin Bolus and Starting Infusion Rate

Standard Protocol Modified Protocol
Heparin Bolus Initial Rate Heparin Bolus Initial Rate
75 units / kg 17 units / kg / hr 60 units / kg 12 units / kg / hr
Heparin Maintenance Infusion
Hold
PTT Heparin Bolus Rate Change Check PTT
Infusion
(seconds) (units / kg) (units / kg / hr) (hrs from previous draw)
(minutes)
<47 Initial bolus x 1 0 ↑ 4 units / kg / hr 6
47 - 70 ½ Initial bolus x 1 0 ↑ 2 units / kg / hr 6
71 - 123 0 0 0 * 6 - 24
124 -166 0 0 ↓ 2 units / kg / hr 6
>166 0 60 ↓ 3 units / kg / hr 6

7. MANAGEMENT
 *a. When two consecutive PTT's are within a 71-123 range, order PTT every twenty-four hours
(at least 4 hours after last PTT drawn).
b. No adjustments are to be made for PTT's drawn less than 4 hours after the last heparin dose adjustment.
c. Document all rate changes on MAR. Make changes as promptly as possible.

8. MONITORING
a. Assess patient for bleeding every shift.
b. Notify physician on rounds (STAT if unstable) if:
any unscheduled interruptions in heparin infusion
platelets less than 100,000/mm3 or decrease of 50,000/mm3
hemoglobin less than 10 gm/dL or decrease of 2 gm/dL
significant bleeding
patient suffers trauma or fall

Time Date
Physician Signature
Distribution: White-Medical Records; Yellow –Pharmacy VBMC 1965-086-0504
WEIGHT-BASED HEPARIN DOSING

Standard Protocol Modified Protocol Maintenance Rate Changes

Weight 75 ½x 17 60 ½x 12 4 3 2
(kilograms) units/kg 75 units/kg units/kg/hr units/kg 60 units/kg units/kg/hr units/kg/hr units/kg/hr units/kg/hr
Bolus Dose Bolus Dose Initial Rate Bolus Dose Bolus Dose Initial Rate Rate Change Rate Change Rate Change
(units) (units) (mL/hr) (units) (units) (mL/hr) (mL/hr) (mL/hr) (mL/hr)
32-34 2000 1000 5 mL/hr 2000 1000 4 mL/hr 1 mL/hr 1 mL/hr 1 mL/hr
35-38 3000 1000 6 mL/hr 2000 1000 5 mL/hr 1 mL/hr 1 mL/hr 1 mL/hr

39-43 3000 1000 7 mL/hr 2000 1000 5 mL/hr 2 mL/hr 1 mL/hr 1 mL/hr

44-48 3000 2000 8 mL/hr 3000 1000 6 mL/hr 2 mL/hr 1 mL/hr 1 mL/hr

49-53 4000 2000 9 mL/hr 3000 2000 6 mL/hr 2 mL/hr 2 mL/hr 1 mL/hr

54-57 4000 2000 9 mL/hr 3000 2000 7 mL/hr 2 mL/hr 2 mL/hr 1 mL/hr

58-62 4000 2000 10 mL/hr 4000 2000 7 mL/hr 2 mL/hr 2 mL/hr 1 mL/hr

63-66 5000 2000 11 mL/hr 4000 2000 8 mL/hr 3 mL/hr 2 mL/hr 1 mL/hr

67-71 5000 2000 12 mL/hr 4000 2000 8 mL/hr 3 mL/hr 2 mL/hr 1 mL/hr

72-75 5000 3000 12 mL/hr 4000 2000 9 mL/hr 3 mL/hr 2 mL/hr 1 mL/hr

76-80 6000 3000 13 mL/hr 4000 2000 9 mL/hr 3 mL/hr 2 mL/hr 2 mL/hr

81-84 6000 3000 14 mL/hr 4000 2000 10 mL/hr 3 mL/hr 2 mL/hr 2 mL/hr

85-89 6000 3000 15 mL/hr 4000 2000 10 mL/hr 4 mL/hr 3 mL/hr 2 mL/hr

90-93 7000 3000 15 mL/hr 4000 2000 10 mL/hr 4 mL/hr 3 mL/hr 2 mL/hr

94-98 7000 3000 16 mL/hr 4000 2000 10 mL/hr 4 mL/hr 3 mL/hr 2 mL/hr

99-103 8000 4000 17 mL/hr 4000 2000 10 mL/hr 4 mL/hr 3 mL/hr 2 mL/hr

104-108 8000 4000 18 mL/hr 4000 2000 10 mL/hr 4 mL/hr 3 mL/hr 2 mL/hr

109-112 8000 4000 19 mL/hr 4000 2000 10 mL/hr 4 mL/hr 3 mL/hr 2 mL/hr

113-116 9000 4000 19 mL/hr 4000 2000 10 mL/hr 5 mL/hr 3 mL/hr 2 mL/hr

117-121 9000 4000 20 mL/hr 4000 2000 10 mL/hr 5 mL/hr 4 mL/hr 2 mL/hr

122-125 9000 4000 21 mL/hr 4000 2000 10 mL/hr 5 mL/hr 4 mL/hr 2 mL/hr

126-130 10000 4000 22 mL/hr 4000 2000 10 mL/hr 5 mL/hr 4 mL/hr 2 mL/hr
131-135 10000 5000 22 mL/hr 4000 2000 10 mL/hr 5 mL/hr 4 mL/hr 2 mL/hr

Standard Regimen Max initial bolus = 10,000 Max repeat bolus = 5,000 Max initial rate =
22 mL/hr
ACS Regimen Max initial bolus = 4,000 Max repeat bolus = 2,000 Max initial rate =
10 mL/hr

Heparin bolus doses rounded to nearest 1000 units

Heparin infusion rates rounded to nearest 100 units/hr