Unique Plan Description: Heparin DVT/PE High Dose PTT Monitored (MJE)
Plan Selection Display: Heparin DVT/PE High Dose PTT Monitored (MJE)
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2016-01-18 06:53:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-05-16 10:07:39
Available at all facilities: Yes

Heparin DVT/PE High Dose PTT Monitored (MJE)
Admit/Discharge/Transfer
		This plan is to be used for patients with diagnoses of deep vein thrombosis or pulmonary embolism and recently received Xa Inhibitors (i.e. Lovenox, Arixtra, Xarelto, Eliquis, Savaysa, Bevyxxa) OR Alteplase (TPA)(NOTE)*
Laboratory
	INR - MH/WH/JE
		Stat, spec type = Blood
	PTT - MH/WH/JE
		Stat, spec type = Blood
		T;N+360, Timed, Q6H, spec type = Blood
IV Solutions
	HEParin 25,000 units/premixed diluent 250 mL
		250 mL, IV, STAT, T;N
			Comment: conc: 100 units/mL. Titrate according to High Dose Weight Based Heparin Protocol.  Maximum weight for dosing 110kg.1) PTT < 64 seconds, bolus 70 units/kg & increase rate by 4 units/kg/hr.2) PTT = 64-80 seconds, bolus 35 units/kg & increase rate by 2 units/kg/hr.3) PTT = 81-135 seconds, (therapeutic range) Do not give bolus & do not change rate.4) PTT = 136-162 seconds, do not bolus. Decrease rate by 2 units/kg/hr.5) PTT = 163 seconds or more, do not give bolus. Stop infusion for 60 mins & decrease rate by 3 units/kg/hr.Upper 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
		70 units/kg, Injection, IV Push, Once, STAT
			Comment: Dose = 70 units/kg Bolus.  Patient on High Dose Heparin Protocol.  Pharmacy to calculate dose.  Begin heparin bolus and infusion immediately after initial stat labs are drawn. (MAXIMUM INITIAL bolus = 7700units)
		70 units/kg, Injection, IV Push, Q6H, PRN for see comment, T;N+360
			Comment: Dose = 70 units/kg Bolus.  PTT < 64 seconds, Patient on High Dose heparin Protocol.  Pharmacy to calculate dose. (MAXIMUM bolus = 7700units)
		35 units/kg, Injection, IV Push, Q6H, PRN for see comment, T;N+360
			Comment: Dose = 35 units/kg Bolus.  PTT level between  64-80 seconds.  Patient on High Dose Heparin Protocol.  Pharmacy to calculate dose. (MAXIMUM bolus = 3800units)
Patient Care
	Notify MD
		T;N, For surgical patients, contact surgeon for approval to start heparin protocol if ordered post surgery
		T;N, if PTT is not in therapeutic range within 24 hours
		T;N, if 2 consecutive 70 unit/kg boluses of heparin given and the PTT is not in therapeutic range within 12 hours
		T;N, if 2 consecutive PTT results are greater or equal to 163 seconds
		T;N, If baseline PTT is >40 seconds (5 seconds above upper normal limit of 22-35 seconds).
	Order Lab
		T;N, Enter orders for PTT Q6Hr timed after initiation of therapy or any dosage change until 2 consecutive PTT in therapeutic range, then q24h in am.
	Avoid IM Injections if possible while on anticoagulants
		T;N

*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