Unique Plan Description: Hparin DVT/PE (High Dose) PTT No Bolus (MJE)
Plan Selection Display: Hparin DVT/PE (High Dose) PTT No Bolus (MJE)
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2022-05-03 17:17:23
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2022-05-04 08:47:21
Available at all facilities: No

Hparin DVT/PE (High Dose) PTT No Bolus (MJE)
Laboratory
	INR - MH/WH/JE
		Stat, spec type = Blood
	PTT - MH/WH/JE
		Stat, spec type = Blood
		T;N+1440, Routine, Q6H, spec type = Blood
IV Solutions
	HEParin 25,000 units/premixed diluent 250 mL
		25,000 units, EVERY BAG, 18 unit/kg/hr
		250 mL, IV, STAT
			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 = 64-81 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
Medications
	HEParin 1000 units/mL injectable solution (JE)
		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  64-81 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