Durham VA Medical Center
WeightBased Heparin Nomogram:
DVT/PE Protocol
Obtain Baseline labs: aPTT, PT/INR, Hgb/Hct, Platelets, Chem7, 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)
WeightBased Heparin Rate Adjustments: Target aPTT 6895 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

4667

40 units/kg

0

↑ 2 units/kg/hr

6 hours

6895**

0

0

No change

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

96106

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/mm^{3},^{ } 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
WeightBased Heparin Nomogram:
DVT/PE Protocol
Obtain Baseline labs: aPTT, PT/INR, Hgb/Hct, Platelets, Chem7, 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)
WeightBased Heparin Rate Adjustments: Target aPTT 6895 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

4667

40 units/kg

0

↑ 2 units/kg/hr

6 hours

6895**

0

0

No change

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

96106

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/mm^{3},^{ } 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
WeightBased Heparin Nomogram:
DVT/PE Protocol
Obtain Baseline labs: aPTT, PT/INR, Hgb/Hct, Platelets, Chem7, 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)
WeightBased Heparin Rate Adjustments: Target aPTT 6895 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

4667

40 units/kg

0

↑ 2 units/kg/hr

6 hours

6895**

0

0

No change

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

96106

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/mm^{3},^{ } 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
WeightBased Heparin Nomogram:
DVT/PE Protocol
Obtain Baseline labs: aPTT, PT/INR, Hgb/Hct, Platelets, Chem7, 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)
WeightBased Heparin Rate Adjustments: Target aPTT 6895 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

4667

40 units/kg

0

↑ 2 units/kg/hr

6 hours

6895**

0

0

No change

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

96106

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/mm^{3},^{ } 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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