PROVIDER MANAGED INTRAVENOUS HEPARIN PROTOCOL PTT MONITORING

**Provider must order each dose adjustment - see algorithm below. NOT A NURSE-MANAGED PROTOCOL**
REGULAR Intensity (PTT Goal: 60 to 100) «LOW» Intensity (PTT Goal: 60 to 80)
PTT PRN RE- INFUSION CHANGE NEXT PTT PTT PRN RE- INFUSION CHANGE NEXT PTT
(seconds) BOLUS HOLD TIME INFUSION (seconds) BOLUS HOLD TIME INFUSION
(optional) DOSE (optional) DOSE
(units/kg/hr) (units/kg/hr)

50 units/kg, Increase by 3 50 units/kg, Increase by 3

< 40 maximum None units/kg/hr 6 hours < 40 maximum None units/kg/hr 6 hours
5,000 units 5,000 units

50 units/kg, Increase by 2 50 units/kg, Increase by 2

40-49 maximum None units/kg/hr 6 hours 40-49 maximum None units/kg/hr 6 hours
5,000 units 5,000 units

25 units/kg, Increase by 1 25 units/kg, Increase by 1

50-59 maximum None units/kg/hr 6 hours 50-59 maximum None units/kg/hr 6 hours
2,500 units 2,500 units

6 hrs 6 hrs
(after 2 (after 2
60-100 None None NO CHANGE consecutive PTTs 60-80 None None NO CHANGE consecutive PTTs
in range, check in range, check
PTT q AM) PTT q AM)
Decrease by Decrease by
101-110 None None 1 units/kg/hr 6 hours 81-100 None None 6 hours
1 units/kg/hr
Decrease by 30 Decrease by
111-120 None None 2 units/kg/hr 6 hours 101-120 None 6 hours
minutes 2 units/kg/hr
30 Decrease by 60 Decrease by
121-150 None minutes 2 units/kg/hr 6 hours 121-150 None 6 hours
minutes 2 units/kg/hr
60 Decrease by 60 Decrease by
151-199 None minutes 3 units/kg/hr 6 hours 151-199 None 6 hours
minutes 3 units/kg/hr
Management of PTT > 200
CHECK TIMING OF SAMPLE INSTRUCTIONS
If < 6 hours since most recent bolus or dose change Continue infusion at current dose, and order repeat PTT at the appropriate time.
> 200
If ≥ 6 hours since most recent bolus or dose change 1. STOP HEPARIN INFUSION.
(potentially contaminated or 2. Order repeat STAT PTT immediately.
improperly timed sample) 3. If repeat PTT < 200, resume heparin according to heparin algorithm. If repeat PTT > 200,
follow steps below.

> 200 1. STOP HEPARIN INFUSION.

(properly timed, non- 2. Order repeat STAT PTT hourly until PTT < 100.
contaminated sample) 3. Then, resume infusion at DECREASED dose that is 4 units/kg/hr lower than previous dose and repeat PTT in 6 hours.