Unique Plan Description: Heparin Non DVT/PE (Low dose) Xa Monitoring (FH)
Plan Selection Display: Heparin Non DVT/PE (Low dose) Xa Monitoring (FH)
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2020-04-12 14:41:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-20 10:55:05
Available at all facilities: Yes

Heparin Non DVT/PE (Low dose) Xa Monitoring (FH)
Admit/Discharge/Transfer
		This plan is to be used for patients with the following diagnoses: atrial fibrillation, chest pain, stroke, MI(NOTE)*
Laboratory
	INR - MH/WH/JE
		Stat, spec type = Blood
	Prothrombin Time (PT) - FH
		T;N, Stat, spec type = Diagnostic Blood
		T;N, Stat, spec type = Therapeutic Blood
	PTT - MH/WH/JE
		Stat, spec type = Blood
		T+2;0400, Timed, Q48H, spec type = Blood
	Partial Thromboplastin Time (PTT) - FH
		T+2;0400, Q48H, Routine, spec type = Diagnostic Blood
		T;N, Stat, spec type = Diagnostic Blood
	Heparin Anti-Xa Heparin
		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, Routine
			Comment: conc: 100 units/mL. Titrate according to Low Dose Weight Based Heparin Protocol.  MAXIMUM INITIAL rate is 1000unit/hr.1)  Anti-factor Xa UFH <than 0.1 units/mL, bolus 60 units/kg & increase rate by 300 units/hr.2)  Anti-factor Xa UFH = 0.1-0.19 units/mL, bolus 30 units/kg & increase rate by 200 units/hr.3)  Anti-factor Xa UFH = 0.2-0.29 units/mL, Do not give bolus & increase rate by 100units/hr.  4) Anti-factor Xa UFH = 0.3-0.7 units/mL (therapeutic range)  Do not bolus and do not change rate.5)  Anti-factor Xa UFH = 0.71-0.8 units/mL, do not bolus. Decrease rate by 100 units/hr.6)  Anti-factor Xa UFH = 0.81-1.7 units/mL, do not give bolus.  Stop infusion for 60 minutes and decrease rate by 200 units/hr when restarted.  7) Anti-factor Xa UFH > 1.7 units/ml.  Stop infusion for 2 hours & decrease rate by 300 units/hr when restarted.
		25,000 units, EVERY BAG, 12 unit/kg/hr
Medications
		No IM injections while on anticoagulants(NOTE)*
	HEParin 1000 units/mL injectable soln
		60 units/kg, Injection, IV Push, Once, STAT
			Comment: Dose = 60 units/kg Bolus.  Patient on Low Dose Heparin Protocol.  Pharmacy to calculate dose. Begin heparin bolus and infusion immediately after initial stat labs are drawn.  (MAXIMUM INITIAL bolus = 5000 units)
		60 units/kg, Injection, IV Push, Q6H, PRN for see comment, T;N+360
			Comment: Dose = 60 units/kg Bolus.  Anti-factor Xa UFH level < 0.1 units/mL, Patient on Low Dose Heparin Protocol.  Pharmacy to calculate dose. (MAXIMUM bolus = 5000 units)
		30 units/kg, Injection, IV Push, Q6H, PRN for see comment, T;N+360
			Comment: Dose = 30 units/kg Bolus.  Anti-factor Xa UFH level between 0.1-0.19 units/mL.  Patient on Low Dose Heparin Protocol.  Pharmacy to calculate dose.  (MAXIMUM bolus = 5000 units)
Patient Care
	Notify MD
		T;N, For surgical patients, contact surgeon for approval to start heparin protocol if ordered post surgery
		T;N, if 2 consecutive 60 unit/kg boluses of heparin given and the resulting anti-factor-Xa UFH is not in therapeutic range within 12 hours
		T;N, if 2 consecutive anti-factor-Xa UFHs are greater or equal to 0.96 units/ml
		T;N, if initial stat anti-factor-Xa UFH comes back elevated.
		T;N, If baseline PTT is >42 seconds (5 seconds above upper normal limit of 22-37 seconds).
		T;N, if critical PTT >135.
	Order Lab
		T;N, Enter orders for anti-factor-Xa UFH Q6Hr timed after initiation of therapy or any dosage change until 2 consecutive anti-factor-Xa UFH in therapeutic range, then q24h in am.
	Avoid IM Injections if possible while on anticoagulants

*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