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Heparin and Insulin Drips

How to correctly initiate and maintain Heparin and Insulin drips per protocol

Adult Heparin Protocol Orders

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.

Heparin Infusion Flow Sheet

This flow sheet is kept in the soft chart and updated with 1. Initiation 2. Rate changes 3. PTT results

Initial Bolus and Dosing Chart

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?

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.

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?

Infusion rates and changes

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.

Heparin Titration

At first 6-hour check

The first 6-hour check after initiating Mr. I.M. Thickes 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. Thickes heparin rate, his PTT is 117.
A. What is our infusion rate?

Heparin Titration Continued

Six hours later

After changing Mr. Thickes 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. Thickes PTT is 109.
A. What do we do? B. And then?

His next PTT is 82.

Whats the plan?

Mr. Thickes Heparin Flowsheet

Things to Remember
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 patients profile