The following questions refer to your patient who is on IV heparin therapy according to the "Standard Weight-Based Heparin Protocol" noted below. The patient weighs 144 pounds. On admission, the patient's APTT is 30 seconds. You initiate IV heparin therapy at 1130 on 06/06/XX. Record your answers in the spaces below unless provided with the "Standard Weight Based Heparin Protocol Worksheet" by

Question

your instructor.

Standard Weight-Based Heparin Protocol
For all patients on heparin drips:
1. Weight in KILOGRAMS required for order to be processed: ______ kg.
2. Heparin 25,000 units in 250 mL of 1/2 NS. Boluses to be given as 1,000 units/mL.
3. APTT q.6h or 6 hours after rate change; daily after two consecutive therapeutic APTTs.
4. CBC initially and repeat every ____ day(s).
5. Obtain APTT and PT/INR on day one prior to initiation of therapy.
6. Guaiac stool initially, then every __ day(s) until heparin discontinued. Notify if positive.
7. Neuro checks every ____ hours while on heparin. Notify physician of any changes.
8. D/C APTT and CBC once heparin drip is discontinued unless otherwise ordered.
9. Notify physician of any bleeding problems.
10. Bolus with 80 units/kg. Start drip at 18 units/kg/h.
11. If APTT is < 35 secs: Rebolus with 80 units/kg and increase rate by 4 units/kg/h.
12. If APTT is 36-44 secs: Rebolus with 40 units/kg and increase rate by 2 units/kg/h.
13. If APTT is 45-75 secs: Continue current rate.
14. If APTT is 76-90 secs: Decrease rate by 2 units/kg/h.
15. If APTT is > 90 secs: Hold heparin for 1 hour and decrease rate by 3 units/kg/h.

At 0600, on 06/07/XX, the patient's APTT is 50 seconds. What should you do now?

When should the APTT be checked again? __________ (hours) on __________ (date)
Fill in the blank(s) with correct word

Answer 1

Maintain the rate at 14 mL/h

Recheck APTT at 0600 on 06/08/XX