HEPARIN Sodium

Usual Diluents

D5W,  NS

Standard Dilutions   [Amount of drug]  [Infusion volume]  [Infusion rate]

[25,000 units] [250 ml] [Titrate] Loading dose: Give IV-push or add to 50 ml D5W.

Stability / Miscellaneous

EXP: 1 DAY (RT).  Cautions: active hemorrhage, acute CVA, History of thrombocytopenia, baseline labs: PT > 15 ; PTT >48; or Platelets < 100,000  Monitoring: PTT q6 to 8 hours following heparin therapy initiation or change in infusion until 2 consecutive therapeutic PTT levels are achieved at a consistent rate of infusion. Once the patient is stabilized, a PTT level should be checked qam. If a patient's PTT does not change significantly from baseline after 2 legitimate attempts to increase dose, consider heparin resistance (antithrombin III deficiency).  Baseline labs: PT, PTT, CBC (Hgb, Hct, platelet count). QOD labs: Hgb, Hct, Platelets.  Labwork requiring physician attention: (1) PTT > 100 sec (2) Platelet count < 100,000 or 40% decrease (3) INR > 3.5 (4) Hemoglobin decrease > 2 gm/dl.  Remember: The most significant factor in reducing recurrent thrombo-embolism is reaching a therapeutic PTT in < 24 hours.  Heparin induced thrombocytopenia: Consider changing to a direct thrombin inhibitor such as Lepirudin.