Unique Plan Description: Heparin DVT/PE (High Dose) PTT Monitoring (MH WH)
Plan Selection Display: Heparin DVT/PE (High Dose) PTT Monitoring (MH WH)
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-02-14 16:34:49
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-20 10:54:03
Available at all facilities: Yes

Heparin DVT/PE (High Dose) PTT Monitoring (MH WH)
Admit/Discharge/Transfer
		This plan is to be used for patients with diagnoses of deep vein thrombosis or pulmonary embolism(NOTE)*
Laboratory
	INR - MH/WH/JE
		Stat, spec type = Blood
	PTT - MH/WH/JE
		Stat, spec type = Blood
		T;N+360, Timed, Q6H, spec type = Blood
IV Solutions
	HEParin 25,000 units/premixed diluent 250 mL
		250 mL, IV, STAT, T;N
			Comment: conc: 100 units/mL. Titrate according to High Dose Weight Based Heparin Protocol.  Maximum weight for dosing 110kg.1) PTT < 52 seconds, bolus 70 units/kg & increase rate by 4 units/kg/hr.2) PTT = 52-64 seconds, bolus 35 units/kg & increase rate by 2 units/kg/hr.3) PTT = 65-110 seconds, (therapeutic range) Do not give bolus & do not change rate.4) PTT = 111-135 seconds, do not bolus. Decrease rate by 2 units/kg/hr.5) PTT = 136 seconds or more, do not give bolus. Stop infusion for 60 mins & decrease rate by 3 units/kg/hr.Upper hard limits for weight based and non-weight based infusions are as follows: 40 units/kg/hour and 3000 units/hour, respectively; if patient needs require exceeding these limits, contact pharmacy and prescriber
		25,000 units, EVERY BAG, 18 unit/kg/hr
Medications
	HEParin 1000 units/mL injectable soln
		70 units/kg, Injection, IV Push, Once, STAT
			Comment: Dose = 70 units/kg Bolus. Patient on High Dose Heparin Protocol.  Pharmacy to calculate dose.  Begin heparin bolus and infusion immediately after initial stat labs are drawn. (MAXIMUM bolus = 7700 units)
		70 units/kg, Injection, IV Push, Q6H, PRN for see comment, T;N+360
			Comment: Dose = 70 units/kg Bolus.  PTT < 52 seconds, Patient on High Dose heparin Protocol.  Pharmacy to calculate dose. (MAXIMUM bolus = 7700 units)
		35 units/kg, Injection, IV Push, Q6H, PRN for see comment, T;N+360
			Comment: Dose = 35 units/kg Bolus.  PTT level between 52-64 seconds.  Patient on High Dose Heparin Protocol.  Pharmacy to calculate dose. (MAXIMUM bolus = 3800 units)
Patient Care
	Notify MD
		T;N, For surgical patients, contact surgeon for approval to start heparin protocol if ordered post surgery
		T;N, if PTT is not in therapeutic range within 24 hours
		T;N, if 2 consecutive 70 unit/kg boluses of heparin given and the PTT is not in therapeutic range within 12 hours
		T;N, For any critical PTT >135 AND with any 2 consecutive PTTs >135
		T;N, If baseline PTT is >42 seconds (5 seconds above upper normal limit of 22-37 seconds).
	Order Lab
		T;N, Enter orders for PTT Q6Hr timed after initiation of therapy or any dosage change until 2 consecutive PTT in therapeutic range, then q24h in am.
	Avoid IM Injections if possible while on anticoagulants
		T;N

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase