Dvt/pe protocol Obtain Baseline labs



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Durham VA Medical Center

Weight-Based Heparin Nomogram:
DVT/PE Protocol


Obtain Baseline labs: aPTT, PT/INR, Hgb/Hct, Platelets, Chem-7, Hepatic enzymes

Monitor Platelet count daily

Document patient’s weight in kg: _______

Initial Bolus 80 units/kg * Calculations based on actual body weight

(MAX DOSE 10,000 units) * Round dose to nearest 100 units * Heparin supplied as 25,000 units/250 mL D5W



Initial Infusion Rate 18 units/kg/hour

(MAX INITIAL RATE 2,000 units/hr)


*Consider reduced dosing of 50 units/kg bolus and 15 units/kg/hour initial rate if elderly, edematous, or morbidly obese.*
Check initial aPTT 6 hours after starting infusion and after any rate adjustments. After two consecutive therapeutic aPTTs, may change aPTT checks to qAM.

Adjust heparin rate using the following chart: (revised 6/2009)
Weight-Based Heparin Rate Adjustments: Target aPTT 68-95 sec

aPTT

(sec)


Bolus Dose (units/kg)

Stop Heparin Infusion (minutes)

Infusion Rate Change

(units/hr)



Next aPTT

(6 full hrs after dose change)



<46

80 units/kg

0

↑ 4 units/kg/hr

6 hours

46-67

40 units/kg

0

↑ 2 units/kg/hr

6 hours

68-95**

0

0

No change

6 hrs (if therapeutic x 2, change checks to qAM)

96-106

0

0

↓ 2 units/kg/hr

6 hours

>106

0

60 min

↓ 4 units/kg/hr

6 hours




  • Notify MD for any of the following: Decrease in Hgb by more than 2 g/dL, decrease in Platelet count by 30% or more from baseline, platelet count less than 100,000/mm3, aPTT above 107 sec, or signs/symptoms of bleeding or worsening thrombosis. Note: Heparin needs a second verifier!


DVT/PE protocol:Physician enters initial Heparin bolus & infusion orders.

Per policy, ICU/ED RN then edits CRPS for rate changes & enters repeat PTT.
Poster developed by CCU nursing team spearheaded by Amber Greene, RN.

Durham VA Medical Center

Weight-Based Heparin Nomogram:
DVT/PE Protocol


Obtain Baseline labs: aPTT, PT/INR, Hgb/Hct, Platelets, Chem-7, Hepatic enzymes

Monitor Platelet count daily

Document patient’s weight in kg: _______

Initial Bolus 80 units/kg * Calculations based on actual body weight

(MAX DOSE 10,000 units) * Round dose to nearest 100 units * Heparin supplied as 25,000 units/250 mL D5W



Initial Infusion Rate 18 units/kg/hour

(MAX INITIAL RATE 2,000 units/hr)


*Consider reduced dosing of 50 units/kg bolus and 15 units/kg/hour initial rate if elderly, edematous, or morbidly obese.*
Check initial aPTT 6 hours after starting infusion and after any rate adjustments. After two consecutive therapeutic aPTTs, may change aPTT checks to qAM.

Adjust heparin rate using the following chart: (revised 6/2009)
Weight-Based Heparin Rate Adjustments: Target aPTT 68-95 sec

aPTT

(sec)


Bolus Dose (units/kg)

Stop Heparin Infusion (minutes)

Infusion Rate Change

(units/hr)



Next aPTT

(6 full hrs after dose change)



<46

80 units/kg

0

↑ 4 units/kg/hr

6 hours

46-67

40 units/kg

0

↑ 2 units/kg/hr

6 hours

68-95**

0

0

No change

6 hrs (if therapeutic x 2, change checks to qAM)

96-106

0

0

↓ 2 units/kg/hr

6 hours

>106

0

60 min

↓ 4 units/kg/hr

6 hours




  • Notify MD for any of the following: Decrease in Hgb by more than 2 g/dL, decrease in Platelet count by 30% or more from baseline, platelet count less than 100,000/mm3, aPTT above 107 sec, or signs/symptoms of bleeding or worsening thrombosis. Note: Heparin needs a second verifier!


DVT/PE protocol:Physician enters initial Heparin bolus & infusion orders.

Per policy, ICU/ED RN then edits CRPS for rate changes & enters repeat PTT.
Poster developed by CCU nursing team spearheaded by Amber Greene, RN.

Durham VA Medical Center

Weight-Based Heparin Nomogram:
DVT/PE Protocol


Obtain Baseline labs: aPTT, PT/INR, Hgb/Hct, Platelets, Chem-7, Hepatic enzymes

Monitor Platelet count daily

Document patient’s weight in kg: _______

Initial Bolus 80 units/kg * Calculations based on actual body weight

(MAX DOSE 10,000 units) * Round dose to nearest 100 units * Heparin supplied as 25,000 units/250 mL D5W



Initial Infusion Rate 18 units/kg/hour

(MAX INITIAL RATE 2,000 units/hr)


*Consider reduced dosing of 50 units/kg bolus and 15 units/kg/hour initial rate if elderly, edematous, or morbidly obese.*
Check initial aPTT 6 hours after starting infusion and after any rate adjustments. After two consecutive therapeutic aPTTs, may change aPTT checks to qAM.

Adjust heparin rate using the following chart: (revised 6/2009)
Weight-Based Heparin Rate Adjustments: Target aPTT 68-95 sec

aPTT

(sec)


Bolus Dose (units/kg)

Stop Heparin Infusion (minutes)

Infusion Rate Change

(units/hr)



Next aPTT

(6 full hrs after dose change)



<46

80 units/kg

0

↑ 4 units/kg/hr

6 hours

46-67

40 units/kg

0

↑ 2 units/kg/hr

6 hours

68-95**

0

0

No change

6 hrs (if therapeutic x 2, change checks to qAM)

96-106

0

0

↓ 2 units/kg/hr

6 hours

>106

0

60 min

↓ 4 units/kg/hr

6 hours




  • Notify MD for any of the following: Decrease in Hgb by more than 2 g/dL, decrease in Platelet count by 30% or more from baseline, platelet count less than 100,000/mm3, aPTT above 107 sec, or signs/symptoms of bleeding or worsening thrombosis. Note: Heparin needs a second verifier!


DVT/PE protocol:Physician enters initial Heparin bolus & infusion orders.

Per policy, ICU/ED RN then edits CRPS for rate changes & enters repeat PTT.
Poster developed by CCU nursing team spearheaded by Amber Greene, RN.

Durham VA Medical Center

Weight-Based Heparin Nomogram:
DVT/PE Protocol


Obtain Baseline labs: aPTT, PT/INR, Hgb/Hct, Platelets, Chem-7, Hepatic enzymes

Monitor Platelet count daily

Document patient’s weight in kg: _______

Initial Bolus 80 units/kg * Calculations based on actual body weight

(MAX DOSE 10,000 units) * Round dose to nearest 100 units * Heparin supplied as 25,000 units/250 mL D5W



Initial Infusion Rate 18 units/kg/hour

(MAX INITIAL RATE 2,000 units/hr)


*Consider reduced dosing of 50 units/kg bolus and 15 units/kg/hour initial rate if elderly, edematous, or morbidly obese.*
Check initial aPTT 6 hours after starting infusion and after any rate adjustments. After two consecutive therapeutic aPTTs, may change aPTT checks to qAM.

Adjust heparin rate using the following chart: (revised 6/2009)
Weight-Based Heparin Rate Adjustments: Target aPTT 68-95 sec

aPTT

(sec)


Bolus Dose (units/kg)

Stop Heparin Infusion (minutes)

Infusion Rate Change

(units/hr)



Next aPTT

(6 full hrs after dose change)



<46

80 units/kg

0

↑ 4 units/kg/hr

6 hours

46-67

40 units/kg

0

↑ 2 units/kg/hr

6 hours

68-95**

0

0

No change

6 hrs (if therapeutic x 2, change checks to qAM)

96-106

0

0

↓ 2 units/kg/hr

6 hours

>106

0

60 min

↓ 4 units/kg/hr

6 hours




  • Notify MD for any of the following: Decrease in Hgb by more than 2 g/dL, decrease in Platelet count by 30% or more from baseline, platelet count less than 100,000/mm3, aPTT above 107 sec, or signs/symptoms of bleeding or worsening thrombosis. Note: Heparin needs a second verifier!


DVT/PE protocol:Physician enters initial Heparin bolus & infusion orders.

Per policy, ICU/ED RN then edits CRPS for rate changes & enters repeat PTT.
Poster developed by CCU nursing team spearheaded by Amber Greene, RN.





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