1 hours ago Avoid adding heparin to the infusion lines of other medications, or piggybacking other drugs into the line used for heparin therapy. To ensure patient safety. Educate the patient about the action, indication, common side effects, and adverse reactions to note when taking heparin. Allow time for the patient to ask questions about the drug. >> Go To The Portal
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 WARNING: Apply pressure to all injection sites after needle is withdrawn; inspect injection sites for signs of hematoma; do not massage injection sites.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.
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.
Therapeutic actions. 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.
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.
Before giving an injection of heparin, check the package label to make sure it is the strength of heparin solution that your doctor prescribed for you. If the strength of heparin is not correct do not use the heparin and call your doctor or pharmacist right away.
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).
Be careful when using sharp objects, including razors and fingernail clippers. Avoid picking your nose. If you need to blow your nose, blow it gently. Check with your doctor right away if you notice any unusual bleeding or bruising; black, tarry stools; blood in the urine or stools; or pinpoint red spots on your skin.
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.
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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.
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.
Here are aspects of care that should be evaluated to determine effectiveness of drug therapy: Monitor patient response to therapy (serum lipid and cholesterol levels). Monitor for adverse effects (e.g. headache, vitamin deficiency, and increased bleeding times.
Nursing Assessment. These are the important things the nurse should include in conducting assessment, history taking, and examination: Assess for the mentioned contraindications to this drug (e.g. hypersensitivity, acute liver disease, pregnancy etc.) to prevent potential adverse effects.
Cholesterol Absorption Inhibitors. Cholesterol absorption inhibitors are one of the new class of drugs approved (2003) to lower serum cholesterol levels. A controversy is linked to this drug because a study in 2008 failed to show positive benefits of combining this class to statins.
Administer drug before meals to ensure that drug is in the GI tract together with food. Administer other drugs 1 hour before or 4-6 hours after bile acid sequestrants to avoid drug interactions. Arrange for a bowel program to effectively address constipation if it ever occurs.
Familial hypercholesterolemia treatment in children is limited to tight dietary restrictions of calorie and fats because lipids in children are important for the development of the nervous system. In cases that are unresponsive to dieta ry restrictions , other classes of antihyperlipidemic are used.
Provide comfort and safety measures to help patient tolerate drug side effects. Educate patient on drug therapy including drug name, its indication, and adverse effects to watch out for to enhance patient understanding on drug therapy and thereby promote adherence to drug regimen.
Bile acid sequestrants are used in combination with HMG-CoA reductase inhibitors for patients whose lipid levels are challenging to normalize with the use of HMG-CoA reductase inhibitors alone. However, for pregnant women, bile acid sequestrants are the drug of choice in lowering cholesterol and lipid levels.
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.
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.