Unique Plan Description: ED PE/DVT Heparin High Dose
Plan Selection Display: ED PE/DVT Heparin High Dose
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2014-03-03 12:44:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-20 10:23:29
Available at all facilities: Yes

ED PE/DVT Heparin High Dose
Laboratory
STAT Lab
	Heparin Anti-Xa Heparin
		T;N+360, Routine, Once, spec type = Blood
		Stat, spec type = Blood
	INR - MH/WH/JE
		Stat, spec type = Blood
	PTT - MH/WH/JE
		Stat, spec type = Blood
	CBC with Diff
		Stat, spec type = Blood
Diagnostic Tests
Radiology
	CTA Chest Pulmonary Arteries
		Stat, Pulmonary Emboli
IV Solutions

	HEParin 25,000 units/premixed diluent 250 mL
		250 mL, IV, STAT, 1 Dose(s)/Time(s)
			Comment: conc: 100 units/mL. Titrate according to High Dose Weight Based Heparin Protocol.  Dosing weight = ____ kg. Maximum weight for dosing 110kg.1)Anti-factor Xa UFH <less than 0.2 units/mL,bolus 70 units/kg & increase rate by 4 units/kg/hr.2)Anti-factor Xa UFH =0.2-0.29 units/mL,bolus 35 units/kg & increase rate by 2 units/kg/hr.3)Anti-factor Xa UFH =0.3-0.7 units/mL,(therapeutic range) Do not give bolus & do not change rate.4)Anti-factor Xa UFH =0.71-0.95 units/mL,do not bolus. Decrease rate by 2 units/kg/hr.5)Anti-factor Xa UFH =0.96 units/mL or more, do not give bolus. Stop infusion for 60 mins & decrease rate by 3 units/kg/hr.Document all rate changes on the Titrated Medication Flowsheet while in EDUpper hard limits for weight based and non-weight based infusions are as follows: 40 units/kg/hour and 3000 units/hour, respectively; if patient needs require exceeding these limits, contact pharmacy and prescriber
		25,000 units, EVERY BAG, 18 unit/kg/hr
Medications
	HEParin 1000 units/mL injectable soln
		35 units/kg, Injection, IV Push, Once, T;N+360
			Comment: Anti-factor Xa UFH level between 0.2-0.29 units/ml. Patient on high dose heparin protocol. Pharmacy to calculate dose. While in ED
		70 units/kg, Injection, IV Push, Once, T;N+360
			Comment: Anti-factor Xa UFH level < 0.2 units/ml Patient on high dose heparin protocol. Pharmacy to calculate dose. While in ED
		70 units/kg, Injection, IV Push, Once, STAT
			Comment: Patient on high dose heparin protocol. Pharmacy to calculate dose. While in ED.
Patient Care
	Notify MD
		T;N, If baseline PTT is >42 seconds (5 seconds above upper normal limit of 22-37 seconds).
Consults/Follow-up
	Consult Hospitalist
		Reason for Referral: PE/DVT

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase