Question below refer to your patient who has left-leg deep vein thrombosis. He h
ID: 238620 • Letter: Q
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Question below refer to your patient who has left-leg deep vein thrombosis. He has orders for IV heparin therapy. He weighs 225 lb. On admission, his aPTT is 25 seconds. You initiate therapy at 1130 on 5/10/xx. Follow the Standard Weight-Based Heparin Protocol (Figure), and record your answers on the Standard Weight-Based Heparin Protocol Worksheet (Figure). According to the protocol, how often should the patient's APTT be checked? qh At 1730, the patient's APTT is 37 seconds. Calculate the new heparin bolus and record your answer on the worksheet. Give -units/kg or units measured as mL Calculate the change in heparin infusion rate (increase or decrease) and record on worksheet. How much should you change the infusion rate?by unitskg/h or mL/h _unitsh for a rate of Calculate the new infusion rate and record on worksheet mL/h Standard Weight-Based Heparin Protocol For all patients on heparin drips 1. Weight in kilograms (round to nearest 10 kg). Required for order to be processed: 2. Heparin 25,000 units in 250 mL of 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 days(s). 5. Obtain aPTT and PT/INR on day 1 prior to initiation of therapy. 6. Guaiac stool initially, then every heparin discontinued. Notify if positive. 7, Neuro checks every hours while on heparin. Notify physician of any changes. 8. Discontinue 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. kg day(s) untilExplanation / Answer
According to the protocol Baseline PT with INR and aPTT prior to initiation of heparin,aPTT q6h and adjust according to sliding scale.May decrease to daily aPTT once two consecutive aPTTs are within the therapeutic range.
225lb=102 kg-rounding of to nearest 10-100 kg
At17.30 -aPTT 37 sec-rebolus 40 units/kg--4000 units(40*100) ----40 ml
[divided by 100(concentration-25000/250) units/ml]
rate change-------increase by 2 units/kg/hr or 200 units/hour, for a rate of 2 ml/hr
new infusion rate at 1730 hour--4000+200=4200 units---------42 ml/hr
1.wt=100 kg
4.baseline CBC , then daily while on heparin
6.everyday
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