Antidote for heparin sodium8/26/2023 ![]() If this cannot be avoided, a minimum discard volume of 5 mL should be collected APTT blood samples should NOT be drawn from the same line (or limb) as the UFH Do NOT turn off UFH infusion prior to collecting an APTT or anti-Xa assay.ĥ. The total infusion, that is, in units/kg/hour.Ĥ. The rate changes suggested in the table above are to be calculated as a percentage of Consult the Clinical Haematology department.ģ. *Bolus may be appropriate depending on clinical situation and perceived bleeding risk. If two unsuccessful attempts to obtain a venous APTT have occurred, contact the Clinical Haematology department before further attempts are made. For most patients one APTT assay every 24 hours is sufficient. Clinical Haematology consultation is recommended to determine ongoing monitoring requirements. Adjust UFH infusion rate to maintain APTT within the range determined as optimal for that patient according to the Nomogram below.This checking of the APTT is to ensure patients are not supra-therapeutic. In most instances, it is not necessary to wake patients overnight for UFH monitoring tests. Obtain venous blood sample for an APTT assay 6 hours post UFH commencement, or as directed by the Clinical Haematology department.Consultation with the Clinical Haematology unit is recommended in such scenarios. Within adult based studies, an anti-Xa assay of 0.35-0.7 units/mL equates to a therapeutic UFH dose. In some clinical scenarios, the APTT may not be accurate, and an anti-Xa assay may be used. APTT results across laboratories cannot be reliably compared. ![]() The table below summarises a UFH dosing nomogram based on the APTT result. *maximum upper limit of 1000 units per hour starting dose breached by Weight x 18 unit/kg/hr calculation. Examples of UFH infusion calculations based on weight and units/kg/hr required All dose calculations are based upon age-appropriate UFH units/kg recommended to achieve therapeutic anticoagulation. The table below provides examples of UFH calculations based upon patient weight. Flow rate (mL per hour) will vary according to weight. Patient Weight x Dose Required (units/kg/hr) / Heparin concentration (units/mL) = mLs/hour to be infusedĩ. Procedures are required, including double checking at the patient bedside. Programing infusion pumps when commencing UFH infusions, careful checking Due to the significant risk for errors in drug calculation, infusion preparation and.Stopped or interrupted for other medication. Patients should have a dedicated line for UFH infusions.Bolus doses of UFH on commencement of therapy are NOT recommended unless specifically requested by the Clinical Haematology team.Recommended age-related UFH dose to commence therapeutic anticoagulation Patients with renal failure will require modified doses and should be discussed with Clinical Haematology. Draw up required units of heparin and volume of diluent If any of these details are missing, the prescribing doctor needs to rechart the orderī. IV orders should state the total dose (units), dose to be administered (units per kilogram per hour) and the volume (mLs per hour) to be infused.If this is necessary, increased vigilance is required and a Clinical Haematology consult is highly recommended. NB Patients that are fluid restricted may require more concentrated UFH solutions than that recommended based on weight. 1000 units in 50 mL (for patients 10 kg and 40 kg).Three concentrations of UFH infusions are used across RCH:.Any patient with a low platelet count or an abnormal APTT or INR should be discussed with a Haematologist prior to starting UFH.Obtain baseline FBE, APTT, INR, Creatinine and renal function.Dose (in units) to be infused per kilogram per hour (eg 20 units/kg/hour).No abbreviation for units will be accepted Total Dose (in units) of UFH in a prepared syringe.Intravenous orders for UFH must state ALL of the following: UFH is compatible with 5% Dextrose and 0.9% NaCl. This guideline applies to the intravenous route only. Outside of Rosella and Koala, the Clinical Haematology Department should be consulted before commencing a UFH infusion Prescribing and administering UFHĪt RCH we only administer UFH by intravenous route. It may be necessary to modify this protocol according to individual patient requirements. The following are guidelines for the commencement and maintenance of Unfractionated Heparin (UFH) infusions, also known as Standard Heparin. These can be accessed from the department’s webpage, or via the links below Unfractionated Heparin (UFH) In addition, the Clinical Haematology department has developed guidelines to support clinician’s management of warfarin and low molecular weight heparin (Clexane). This page contains Clinical Practice Guidelines for the administration of Standard Heparin infusions, systemic lytic therapy and the management of a blocked central venous access device.
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