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Your patient weighs 96 lb. The doctor orders Heparin for the patient, a bolus of 60 units/kg to be pushed over 5 minutes and an infusion to run 14 units/kg/hr. You have Heparin Sodium with a concentration of 800 units/mL available for the bolus. For the infusion you have bags with 25,000 units of Heparin in 1000 mL D5W.
In addition, every six hours the patient’s blood will be tested for clotting time, and the aPTT result will be determined. Here is the heparin protocol to be used.
|
aPTT Result |
Bolus Dose |
Hold time (min) for Infusion |
Change to Infusion Rate |
|
|
Less than 55 |
15 units/kg |
No hold |
Increase 4 units/kg/hr |
|
|
55-69 |
10 units/kg |
No hold |
Increase 2 units/kg/hr |
|
|
70-79 |
5 units/kg |
No hold |
Increase 1 unit/kg/hr |
|
|
80-100 |
No bolus given |
No hold |
No Change |
|
|
101-110 |
No bolus given |
No hold |
Decrease 1 unit/kg/hr |
|
|
111-120 |
No bolus given |
30 |
Decrease 2 unit/kg/hr |
|
|
121-140 |
No bolus given |
60 |
Decrease 3 units/kg/hr |
|
|
More than 140 |
No bolus given |
90 |
Decrease 5 units/g/hr |
|
Question: At what rate to set the initial IV infusion.