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Heparin
Indication
Bolus dose
(Units/kg)
Maximum bolus
(Units)
Initial infusion
U/kg/h
Maximum
Initial infusion rate
U/kg/h
80
80
70
60
10,000
5,000
5,000
4000
18
18
15
12
1,800
1,000
1,200
1,000
Body Weight
kg.
Bolus
Units
Initial infusion
Heparin 2ml (10,000 U) + NSS 100 ml (100 Units/ml)
IV drip
ml/h
( Units/kg/h)
Adjustment
aPTT ratio
Repeated bolus dose
(Units)
Stop infusion
duration
(min)
Change rate of infusion
Time to next aPTT (hours)
>7
-
180
Reduce rate by 500 U/h (5ml/h)
3
5.1-7.0
-
60
Reduce rate by 500 U/h (5ml/h)
6
4.1-5.0
-
30-60
Reduce rate by 300 U/h (3ml/h)
6
3.1-4.0
-
30-60
Reduce rate by 200 U/h (2ml/h)
6
2.6-3.0
-
30-60
Reduce rate by 100 U/h (1ml/h)
6
1.8-2.5
-
0
No change
Next morning
1.2-1.7
2,500
0
Increase rate by 100-200 U/h (1-2 ml/h)
6
<1.2
5,000
0
Increase rate by 400 U/h (4 ml/h)
6
Monitoring
Vital signs (BP, HR, RR)
-
Observe neurological sign
-
Observe bleeding
-
Lab
-
PTT keep <70 sec,
-
aPTTratio (keep < 2.5) q 4-6 h
-
platelet, Hct q 2 days
-
ตรวจสอบปริมาณยาที่เหลือตามแผนการรักษา
Notify if...
-
Neurological sign change
-
PTT >/= 70 sec
-
aPTT ratio > 2.5
-
Platelet < 100,000 /mm3
-
Hct drop > 3% from baseline
-
invasive catheter bleeding/hematoma
-
heparin infusion pump error
-
Antidote: Protamine 1 - 1.5mg/100U of heparin (25-50 mg, Maximum 50 mg) slow injection in 10 minutes
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