Unique Plan Description: HIT Drip Protocol - bivalirudin (Angiomax) (FH)
Plan Selection Display: HIT Drip Protocol - bivalirudin (Angiomax) (FH)
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2020-04-22 18:56:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-05-04 13:38:47
Available at all facilities: Yes

HIT Drip Protocol - bivalirudin (Angiomax) (FH)
Laboratory
	CBC with Diff
		T;N, Stat, spec type = Blood
		T;N, Routine, spec type = Blood
			Comment: D/C once Therapeutic
	Partial Thromboplastin Time (PTT) - FH
		T;N, Stat, spec type = Diagnostic Blood
		T;N, Q2H-Sch, Routine, spec type = Diagnostic Blood
			Comment: D/C once Therapeutic
	Prothrombin Time (PT) - FH
		Q24H, Timed, spec type = Diagnostic Blood
IV Solutions
		Bivalrudin is a direct thrombin inhibitor anticoagulant that may be given to patients in the ICU who have suspected or confirmed HIT.  The medication may also be given to anticoagulate patients who have a history of HIT(NOTE)*
	Angiomax 250mg/NS 250mL
		250 mL, IV
			Comment: Comment: RP to Adjust Initial Dose based on Renal Function:- Normal >60mL/min = 0.14 mg/kg/hrCrCl 30-60mL/min = 0.10 mg/kg/hr CrCl  < 30mL/min = 0.05 mg/kg/hrDialysis = 0.04 mg/kg/hrUSE ACTUAL BODY WEIGHT-Round To Nearest 5kgDose Adjustment: aPTT<45 Increase rate by 0.01 mg/kg/hr45-59 Increase rate by 0.005 mg/kg/hr60-80 NO CHANGE = GOAL RANGE81-95 decrease by 0.005 mg/kg/hr96-110 HOLD infusion for 2 hour, then decrease by 0.01 mg/kg/hr>110 HOLD infusion for 2 hours, ONCE AT GOAL: decrease rate by 0.01 mg/kg/hr. Discontinue Q2hr aPTT order once patient therapeutic
		250 mg, EVERY BAG, 0.14 mg/kg/hr
Patient Care
	Fall Precautions
		T;N
	Discontinue Medication
		T;N, Discontinue all Heparin or LMWH (low molecular weight heparin) orders.
	Notify MD
		T;N, Signs of bleeding - new ecchymosis, epistaxis, petechiae, mematoma, hematuria.
			Comment: Signs of retroperitoneal bleeding - abdominal, hip or back pain,   lower extremity weakness, increased abdominal firmness, or   acute hypotensive episode- Drop in hemoglobin > 2g/dL
Consults/Follow-up
	Pharmacy Consult
		T;N, 1.  Review History for documented Heparin-Induced Thrombocytopenia.  If documented: Update Heparin as an ALLERGY 2. Discontinue all heparin/LMWH orders

*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