Unique Plan Description: protamine Reversal of enoxaparin
Plan Selection Display: protamine Reversal of enoxaparin
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-01-13 14:36:45
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2022-07-05 13:50:21
Available at all facilities: Yes

protamine Reversal of enoxaparin
Medications
		     There is not a complete antidote for enoxaparin.  Protamine only reverses approximately 60% of the enoxaparin dose.(NOTE)*
		Reveral for enoxaparin given within the last 8 hours(NOTE)*
		       protamine dose is 1 mg for every 1 mg enoxaparin administered (maximum recommended dose of 50mg).  If bleeding continues and if anti-Xa LMWH and/or PTT is prolonged at 4 hrs after initial infusion, half the original dose may be repeated.(NOTE)*
	protamine
		mg, Injection, IVPB, Once, NOW, 30 ml/hr
			Comment: Nurse to monitor patient continuously for the first 10min; if patient tolerates infusion for 10min (no increased hypotension, bradycardia, anaphylaxis), rate may be increased to 90ml/hr for remainder of the infusion.  VS to be monitored every 5min.
		Reversal for enoxaparin given 8-12 hours ago:(NOTE)*
		     Protamine dose is 0.5 mg for every 1 mg of enoxaparin administered (maximum recommended dose of 50mg).(NOTE)*
		mg, Injection, IVPB, Once, NOW, 30 ml/hr
			Comment: Nurse to monitor patient continuously for the first 10min; if patient tolerates infusion for 10min (no increased hypotension, bradycardia, anaphylaxis), rate may be increased to 90ml/hr for remainder of the infusion.  VS to be monitored every 5min.
		Patients currently on/previously treated with protamine sulfate containing insulin (NPH), have undergone vasectomy, or have known fish allergies may have a greater risk for hypersensitivity reactions.(NOTE)*
	diphenhydrAMINE
		25 mg, Injection, IV Push, Once, PRN for allergy symptoms
			Comment: with protamine
	methylPREDNISolone
		125 mg, Injection, IV Push, Once, PRN for wheezing and/or shortness of breath
			Comment: with protamine
	EPINEPHrine
		0.3 mg, Injection, SUBCUTANEOUS, Once, PRN for wheezing and/or shortness of breath
			Comment: with protamine
Patient Care
	Order Lab
		T;N, PTT to be drawn 4 hours after protamine infusion complete. Nurse to enter lab.
		T;N, Heparin Anti-Xa LMWH Lovenox to be drawn 4 hours after protamine infusion complete. Nurse to enter lab.
	Cardiac Telemetry Monitoring
		Telemetry Indications: Other
			Comment: during protamine infusion only, dc when infusion complete

*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