3 hours ago · Knowing this drug is ototoxic, the nurse should: a. advise the patient to discontinue the medication at the first sign of dizziness. b. instruct the patient to use the Valsalva maneuver to equalize middle ear pressure to prevent hearing loss. c. instruct the patient to report any signs of tinnitus, dizziness, or difficulty hearing. >> Go To The Portal
Call your doctor or notify your nurse if you are taking heparin and you have these side effects: Trouble breathing, fast breathing or wheezing. Bleeding that will not stop.
Full Answer
The benefit of monitoring IV heparin once a therapeutic threshold has been exceeded is not well defined. We suggest monitoring of continuous infusion heparin therapy, either using aPTT or anti-Xa, as this is considered standard of care despite the weak evidence base. Monitoring is optional in those receiving SC weight-based heparin therapy. (5)
Nursing considerations. WARNING: Apply pressure to all injection sites after needle is withdrawn; inspect injection sites for signs of hematoma; do not massage injection sites. Mix well when adding heparin to IV infusion. Do not add heparin to infusion lines of other drugs, and do not piggyback other drugs into heparin line.
Your medical team will check to see how well heparin is working with a test called the partial thromboplastin time (PTT). This test will let them know how long it takes for your blood to clot.
There are no prospective trials evaluating heparin dosing regimens using different weight strategies, although a trial in obese patients (NCT01361193) is ongoing. Current dosing recommendations do not specify which weight should be used.
Rationale: When caring for a client who is receiving heparin, the nurse should monitor the aPTT to evaluate medication effectiveness. The aPTT evaluates the intrinsic and final common pathways of the coagulation cascade that are affected by heparin.
Assess for signs of bleeding and hemorrhage, including bleeding gums, nosebleeds, unusual bruising, black/tarry stools, hematuria, and fall in hematocrit or blood pressure. Notify physician or nursing staff immediately if heparin causes excessive anticoagulation.
When assessing therapeutic levels of unfractionated Heparin, two laboratory tests are available; the Activated Partial Thromboplastin Time (aPTT) and the Anti-Factor Xa Assay. The aPTT has been the gold standard for monitoring IV heparin for more than 50 years. It is cost-effective and familiar to most personnel.
Most Heparin protocols dictate that the nurse would hold the infusion for 1 hour and to decrease the rate of infusion. If the aPTT is less than 60 seconds, the dose would need to be increased and a bolus may be needed. aPTT values should be around 60-80 seconds to achieve a therapeutic response for Heparin.
Laboratory monitoring is widely recommended to measure the anticoagulant effect of unfractionated heparin and to adjust the dose to maintain levels in the target therapeutic range. The most widely used laboratory assay for monitoring unfractionated heparin therapy is the activated partial thromboplastin time (aPTT).
Heparin side effectsbruising more easily.bleeding that takes longer to stop.irritation, pain, redness, or sores at the injection site.allergic reactions, such as hives, chills, and fever.increased liver enzymes on liver function test results.
Anticoagulant or anti-thrombotic drugs such as Heparin and Low Molecular Weight Heparin will cause the INR to be higher because they are affecting the coagulation cascade directly.
The therapeutic goal for a patient being anticoagulated with heparin, is an aPTT approximately 1.5 to 2.5 times the mean normal value.
PTT is commonly used in clinical practice to monitor unfractionated heparin infusion to target therapeutic range of anticoagulation and as part of coagulation panels to help elucidate causes of bleeding or clotting disorders.
Administer heparin as prescribed, taking in consideration the most recent coagulation test results. To ensure medicine compliance and lower the risk for bleeding to develop. Avoid giving intramuscular injections to the patient once heparin therapy has started. Heparin increases the risk of hematoma formation.
Common side effects of Heparin are: easy bleeding and bruising; pain, redness, warmth, irritation, or skin changes where the medicine was injected; itching of your feet; or.
Do not add heparin to infusion lines of other drugs, and do not piggyback other drugs into heparin line. If this must be done, ensure drug compatibility. Provide for safety measures (electric razor, soft toothbrush) to prevent injury from bleeding. Check for signs of bleeding; monitor blood tests.
Heparin increases the inhibitory action of antithrombin III (AT III) on clotting factors XIIa, XIa, IXa, Xa and thrombin. This inhibits the conversion of prothrombin to thrombin and fibrinogen to fibrin. It also inhibits platelet function. It may reduce the activity of ATIII at very high doses.
Mix well when adding heparin to IV infusion. Do not add heparin to infusion lines of other drugs, and do not piggyback other drugs into heparin line. If this must be done, ensure drug compatibility. Provide for safety measures (electric razor, soft toothbrush) to prevent injury from bleeding.
The drug heparin is sometimes given as an infusion through an IV line. It is important to have your blood drawn and tested to get the correct amount of heparin in your blood. Your medical team will check to see how well heparin is working with a test called the partial thromboplastin time (PTT).
You may also get heparin to prevent blood clots after procedures, surgeries, or injuries that keep you from being able to move around, such as joint replacement surgeries .
Heparin may be the first treatment you get if you have a venous thromboembolism (VTE), also known as a blood clot. Such clots can be serious. You might have a clot in a deep vein, like one in the leg or arm. This is called a deep vein thrombosis or DVT. If the DVT breaks loose from the wall of the vein and travels to the lungs, ...
Heparin is a drug that helps to prevent blood clots. A heparin infusion delivers heparin through an IV line in your vein. Side effects include bruising and unexpected bleeding.
Call your doctor or notify your nurse if you are taking heparin and you have these side effects: Trouble breathing, fast breathing or wheezing. Bleeding that will not stop. Bruising, rash or patches on the skin. Rash or patches on the skin. Sudden weakness or numbness on one side of the body.
Veins are the most common type of blood vessels used. When a catheter is placed in a vein it is called an "IV line.".
Some infusion therapy is done in a hospital, but it is possible that you could have home infusion therapy. Your medical team will give you the information that you need if you are having infusion therapy at home or in the hospital.
Heparin requires close monitoring because of its narrow therapeutic index, increased risk for bleeding, and potential for heparin-induced thrombocytopenia (HIT). Monitoring includes thorough head-to-toe patient assessments for potential side effects, and laboratory monitoring.
Nurse-driven heparin nomograms for IV heparin administration are used at JHH to manage many adult patients’ anticoagulation needs.
Indication#N#Low Molecular Weight Heparin (LMWH), like UFH, is used for treat-ment and prevention of VTE. There are several advantages of LMWH over UFH: longer half-life, higher bioavailability, a predictable dose response, and decreased risk for HIT. Dosing is based on patient weight, administration schedule, and patient-specific considerations.
Heparin-induced thrombocytopenia (HIT) is an antibody-mediated reaction characterized by a profound decrease in platelets—typically a 50% reduction in the platelets from baseline2—within 5 to 10 days after exposure to heparin. It is a potentially life-threatening condition and causes thrombosis in approximately 50% of affected patients.
For example, active hepatic disease, certain drugs, and old age are likely to enhance the response to warfarin. The International Normalized Ratio (INR) is the recommended method for monitoring warfarin, and the target goal is set by the provider, based on clinical indication.
Warfarin has a narrow therapeutic index, so monitoring includes assessment for potential side effects, laboratory tests for dose titration, and vigilance for potential drug and food interactions. Bleeding is the most common side effect , most frequently in the GI tract.
Foods containing vitamin K may decrease anticoagulation and INR. Patient Education. Patient education topics for the patient on warfarin include medication adherence, INR target, importance of laboratory monitoring, and necessity of communicating changes in their medication regime to health-care provider.
After deep subcutaneous (intrafat) injections, tests for adequacy of dosage are best performed on samples drawn 4 to 6 hours after the injection. Periodically monitor platelet counts, hematocrit, and occult blood in stool during the entire course of Heparin therapy, regardless of the route of administration.
Heparin-induced thrombocytopenia (HIT) is a serious antibody-mediated reaction. HIT occurs in patients treated with Heparin and is due to the development of antibodies to a platelet Factor 4-Heparin complex that induce in vivo platelet aggregation.
Therefore, when Heparin sodium is given with dicumarol or warfarin sodium, a period of at least 5 hours after the last intravenous dose or 24 hours after the last subcutaneous dose should elapse before blood is drawn, if a valid prothrombin time is to be obtained.
In a published study conducted in rats and rabbits, pregnant animals received Heparin intravenously during organogenesis at a dose of 10,000 units/kg/day, approximately 10 times the maximum human daily dose based on body weight. The number of early resorptions increased in both species.
Thrombocytopenia. Thrombocytopenia in patients receiving Heparin has been reported at frequencies up to 30%. It can occur 2 to 20 days (average 5 to 9) following the onset of Heparin therapy. Obtain platelet counts before and periodically during Heparin therapy.
When Heparin is added to an infusion solution for continuous intravenous administration, the container should be inverted at least six times to ensure adequate mixing and prevent pooling of the Heparin in the solution.
Drugs such as NSAIDS (including salicylic acid, ibuprofen , indomethacin, and celecoxib), dextran, phenylbutazone, thienopyridines, dipyridamole, hydroxychloroquine, glycoprotein IIb/IIIa antagonists (including abciximab, eptifibatide, and tirofiban), and others that interfere with platelet-aggregation reactions (the main hemostatic defense of Heparinized patients) may induce bleeding and should be used with caution in patients receiving Heparin sodium. To reduce the risk of bleeding, a reduction in the dose of antiplatelet agent or Heparin is recommended.
The analysis was conducted because errors in heparin administration can have severe consequences for patients and , in spite of previous attempts to standardize the heparin administration process throughout the hospital, errors still occurred at unacceptably high rates.
Heparin administration errors can have severe consequences for patients. Despite a previous attempt to standardize the heparin administration process through the use of a computerized protocol at a large Midwestern hospital, errors still occurred at unacceptably high rates. A Heparin Error Reduction Workgroup (HERW)—consisting of staff nurses, pharmacists, and a cardiologist—was convened in 2002 to address the issue. The HERW asked human factors consultants to conduct a human factors process analysis of the nursing staff’s heparin administration procedures. The consultants observed the work process involving heparin administration in several nursing stations and conducted interview sessions with (1) the physician and pharmacist who developed the heparin protocols; (2) staff pharmacists; (3) nursing administrators; (4) nurse educators; and (5) nurses from cardiovascular nursing stations where heparin is administered extensively, and medical/surgical nursing stations where it is used less frequently. After analyzing the information collected in the interviews and observations, the consultants recommended changes to make the computerized heparin dosing interface more user-friendly, for example, presenting no more than three responses per computer screen to the practitioner, and automatically interconverting English and metric weight and height measurements. The HERW approved and implemented many of the recommendations. The revised heparin dosing computer interface was then tested by a representative sample of nurses and pharmacists from all areas of the hospital. Further modifications were made based on feedback from the participants in the test. A 5-day educational process was then instituted to inform practitioners about the new heparin administration procedure. Following the education, the upgraded computer-driven procedure was implemented hospitalwide. This new procedure has been very well received by the nurses who administer heparin. In the first quarter following implementation of the recommendations, there was an 11.4 percent reduction in the type of heparin errors that resulted in increased monitoring or harm to patients on the cardiovascular nursing stations. In the subsequent quarter (4Q2003), there was a
The heparin dosing terms should be clarified. The terms “therapeutic” and “prophylactic” should not be used. Instead, they should be replaced with the terms “high” and “low.” However, if discontinuing the use of the terms therapeutic or prophylactic would confuse health care practitioners, then the terms “therapeutic (high)” and “prophylactic (low)” should be used. This change should help to eliminate confusion regarding appropriate dosing levels. (It should be noted that this recommendation was not adopted. Hospital personnel decided to continue to use the terms therapeutic and prophylactic in order to minimize the problems that may have accompanied the transition to the recommended terms and because therapeutic and prophylactic are the literature standard when referring to heparin therapy and its indications. For purposes of clarity, therapeutic and prophylactic are used in the remainder of the paper.)
Physician order forms should be modified to reflect the changes recommended above for computer data entry, minimizing ambiguity, and making written orders consistent with computer-generated orders. In written orders, the physician should indicate (1) whether the patient is male or female (but not pregnant) or female (and pregnant), (2) whether the heparin dose to be administered to the patient is therapeutic or prophylactic, (3) whether a prophylactic dose is to be administered by intravenous infusion or subcutaneously, and (4) whether subcutaneously delivered heparin should be Lovenox or Not Lovenox.