heparin infusion and titration

what class of drug is heparin?

anticoagulant, antithrombotic

what are the two causes of strokes?

clot or brain bleed

IV INFUSION: BOLUS available: 25,000 units in 250mL 1/2 NS order: initial bolus is 60 units a kg and initial rate is 12 units/kg/hr lbs: 145 - calculate the bolus - 60 units/kg

convert lbs to kg (65.9 kg) round weight to nearest whole number (66 kg) 60 x 66 = 3960 units bolus is given IV push

when assessing the patient, where should the nurse look for bleeding?

gums, urine, stool, skin (petechiae), decrease in lab levels of Hgb, Hct, and plt

A patient that is on heparin and has 2 consecutive therapeutic readings of INR being 2.5. What is the next action by the HCP in response to these INR levels?

heparin is d/c and only PO admin of Coumadin is administered to the pt

what is the action of heparin?

prevents conversion of fibrinogen to fibrin and prothrombin to thrombin

what is the important safety measure to take with a patient receiving insulin?

starting with a PTT and Plt baseline, to best evaluate changes or potential complications

When calculating heparin titration: IV infusion --> initial infusion rate, what is the initial infusion rate rounded to?

the nearest tenth! ex. 7.9 mL/hr = 7.9 mL/hr (not 8 mL/hr)

when calculating heparin titration: IV infusion --> bolus and/or initial infusion rate, what is the weight of the patient rounded to?

the nearest whole number! ex. 65.9 kg = 66 kg

what are side effects of Heparin administration?

thrombocytopenia hemorrhage anemia hematuria

this is increasing or decreasing the drip to achieve a therapeutic range

titrating

how long should you draw blood for PTT levels every 6 hours?

until you have 2 consecutive values within the goal range, then evaluate a PTT every morning

Other than heparin, what other PO medication are A-Fib patients put on when they have been on heparin for a certain period of time.

Coumadin

This is a hypersensitivity response of the immune system to heparin and causes thrombocytopenia

Heparin Induced Thrombocytopenia (HIT)

what are some situations where heparin is used?

PE, ACS/MI, stroke, DVT/VTE, a-fib, DIC, - also for the patency of special IV lines (ports, dialysis catheters)

Which baseline lab level helps in titration of heparin?

PTT

What labs should a patient on heparin have frequently monitored?

PTT and platelet count

what routes can heparin be given?

SQ / IV push / IV infusion

available: 25,000 units in 250mL 1/2 NS order: initial bolus is 60 units a kg and initial rate is 12 units/kg/hr lbs: 145 - calculate the initial infusion rate: 12 units/kg/hr

12 units x 66 kg = 792 units calculate concentration --> 25,000 / 250 = 100 units/ml 792 units/hr / 100 units/ml = 7.9 ROUND TO THE NEAREST TENTH

how to calculate the concentration of heparin?

25,000 units/ 250ml NS = 100 units/mL

Patients are put on heparin when they are admitted into the hospital with this medical Dx (esp in this Dx)

A-Fib