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Heparin and Insulin DripsHow to correctly initiate and maintain Heparin
and Insulin drips per protocol
Found in the p drive under Columbia/Forms/Adult Heparin Protocol Orders
Affix patient label, date and time Draw PT/PTT and a CBC BEFORE starting the heparin
drip Draw a CBC with Platelet count every 3 days while on
the drip Starting day 3 of therapy, draw a daily PT 6 hours after the drip is initiated, draw a PTT With the PTT results, titrate the infusion per the sliding
scale. When the PTT is therapeutic for 2 consecutive blood draws, maintain the infusion and order daily PTTs.
Adult Heparin Protocol Orders
Heparin Infusion Flow
SheetThis flow sheet is kept in the soft chart and updated with
1. Initiation2. Rate changes3. PTT results
Initial Bolus and Dosing Chart
Actual body weight ____kg (round to the nearest 5 kg) For patients with
weighing less than 40 kg, give a 70 unit/kg bolus, then 16 units/kg/hr infusion
Use the infusion rate adjustment listed for greater than 40 kg.
Mrs. I. B. Clotte is ordered for a heparin drip. Her weight is 39.6 kg and her baseline PTT is 35. A. What weight are we
going to use to initiate the orders?
B. What dose is our bolus?
C. What is our initial infusion rate?
Initial Bolus and Dosing Chart
Ms Tia Stroke weights 133.7 kg. Her initial PTT is 137. A. What weight are
we going to use to initiate the orders?
B. What is our next step?
Dr. M orders a heparin drip for Mr. I.M. Thicke. Mr. Thicke weighs 181.7 kg. After obtaining his labs, his baseline PTT is 74. A. What weight are we
going to use to initiate the orders?
B. What is our bolus dose? C. What is our beginning
infusion rate?
After starting the initial infusion rate, draw a PTT in 6 hrs.
Using the result of the PTT, adjust the rate per the sliding scale.
Infusion rates and changes
Heparin Titration
At first 6-hour check
The first 6-hour check after initiating Mr. I.M. Thicke’s heparin bolus, his PTT is 54. His drip is running at 18 ml/hr. A. What is our next step? B. What is our infusion
rate?
At the next 6-hour check
Six hours after changing Mr. Thicke’s heparin rate, his PTT is 117. A. What is our infusion
rate?
Heparin Titration Continued
Six hours later…
After changing Mr. Thicke’s rate to 21 ml/hr, his PTT is 127. A. What is the next step? B. What is the new
infusion rate?
And another 6 hours
After changing his infusion rate again, Mr. Thicke’s PTT is 109. A. What do we do? B. And then?
His next PTT is 82. What’s the plan?
Mr. Thicke’s Heparin Flowsheet
If at any time the PTT is greater than 130, HOLD the drip, recheck PTT every 2 hours, until less than 115. Restart heparin drip at reduced rate according to the chart
Hemoccult all stools and NG aspiration and notify MD of positive results
Make sure protamine sulfate is on the patient’s profile
Things to Remember