heparin Nursing Considerations & Management

 Drug Name

Generic Name : heparin , heparin sodium injection, heparin sodium and 0.9% sodium chloride, heparin sodium lock flush solution

Brand Name:  Hepalean (CAN), Heparin Leo (CAN) , Hepalean-Lok (CAN), Heparin Lock Flush, Hep-Lock, Hep-Lock U/P

Classification: Anticoagulant

Pregnancy Category C

Dosage & Route

Available forms :Injection—1,000, 2,000, 2,500, 5,000, 7,500, 10,000, 12,500, 20,000, 40,000 units/mL; also single-dose and unit-dose forms; lock flush solution—10, 100 units/mL.

Dosages : Adjust dosage according to coagulation tests. Dosage is adequate when WBCT = 2.5–3 times control—or aPTT = 1.5–2 times control value. The following are guidelines to dosage:

ADULTS

Subcutaneous (deep subcutaneous injection)

  • For general anticoagulation: IV loading dose of 5,000 units and then 10,000–20,000 units subcutaneously followed by 8,000–10,000 units q 8 hr or 15,000–20,000 units q 12 hr.
  • Prophylaxis of postoperative thromboembolism: 5,000 units by deep subcutaneous injection 2 hr before surgery and q 8–12 hr thereafter for 7 days or until patient is fully ambulatory.

IV

  • Intermittent IV: Initial dose of 10,000 units and then 5,000–10,000 units q 4–6 hr.
  • Continuous IV infusion: Loading dose of 5,000 units and then 20,000–40,000 units/day.
  • Surgery of heart and blood vessels for patients undergoing total body perfusion: Not less than 150 units/kg; guideline often used is 300 units/kg for procedures less than 60 min, 400 units/kg for longer procedures.
  • Clot prevention in blood samples: 70–150 units/10–20 mL of whole blood.
  •  Heparin lock and extracorporeal dialysis: See manufacturer’s instructions.
PEDIATRIC PATIENTS
  • Initial IV bolus of 50 units/kg and then 100 units/kg IV q 4 hr, or 20,000 units/m2 per 24 hr by continuous IV infusion.
Therapeutic actions
  • Heparin increases the inhibitory action of antithrombin III (AT III) on clotting factors XIIa, XIa, IXa, Xa and thrombin. This inhibits the conversion of prothrombin to thrombin and fibrinogen to fibrin. It also inhibits platelet function. It may reduce the activity of ATIII at very high doses.
Indications
  • Prevention and treatment of venous thrombosis and pulmonary embolism
  • Treatment of atrial fibrillation with embolization
  • Diagnosis and treatment of DIC
  • Prevention of clotting in blood samples and heparin lock sets and during dialysis procedures
  • Unlabeled uses: Adjunct in therapy of coronary occlusion with acute MI, prevention of left ventricular thrombi and CVA post-MI, prevention of cerebral thrombosis in the evolving CVA
Adverse effects
  • Slight fever, headache, chills, nausea, vomiting, constipation, epistaxis, bruising, slight haematuria, skin necrosis (SC inj), osteoporosis, alopecia. Hypersensitivity reactions include urticaria, conjunctivitis, rhinitis, asthma, angioedema and anaphylactic shock. Priapism.
  • Potentially Fatal: Heparin-induced thrombocytopenia with or without thrombosis; bleeding.
Contraindications
  • Patients predisposed to active bleeding including thrombocytopenia, peptic ulcer disease, cerebrovascular disorders, haemorrhagic blood disorders, bacterial endocarditis, severe hypertension, oesophageal varices. Recent surgery at sites where haemorrhage would be an especial risk. Severe renal and hepatic impairment. Cerebral or subarachnoid haemorrhage, abdominal or thoracic bleeding into closed space, severe traumatic bleed, hepatic, renal, splenic or arterial injury, severe haemostatic defect, arterial thrombosis with heparin-associated thrombocytopenia. IM admin.
Nursing considerations
Assessment
  • History: Recent surgery or injury; sensitivity to heparin; hyperlipidemia; pregnancy
  • Physical: Peripheral perfusion, R, stool guaiac test, PTT or other tests of blood coagulation, platelet count, renal function tests
Interventions
  • Adjust dose according to coagulation test results performed just before injection (30 min before each intermittent dose or q 4–6 hr if continuous IV dose). Therapeutic range aPTT: 1.5–2.5 times control.
  • Always check compatibilities with other IV solutions.
  • Use heparin lock needle to avoid repeated injections.
  • Give deep subcutaneous injections; do not give heparin by IM injection.
  • Do not give IM injections to patients on heparin therapy (heparin predisposes to hematoma formation).
  • WARNING: Apply pressure to all injection sites after needle is withdrawn; inspect injection sites for signs of hematoma; do not massage injection sites.
  • Mix well when adding heparin to IV infusion.
  • Do not add heparin to infusion lines of other drugs, and do not piggyback other drugs into heparin line. If this must be done, ensure drug compatibility.
  • Provide for safety measures (electric razor, soft toothbrush) to prevent injury from bleeding.
  • Check for signs of bleeding; monitor blood tests.
  • Alert all health care providers of heparin use.
  • WARNING: Have protamine sulfate (heparin antidote) readily available in case of overdose; each mg neutralizes 100 units of heparin.
  • WARNING: Treatment of overdose: Protamine sulfate (1% solution). Each mg of protamine neutralizes 100 USP heparin units. Give very slowly IV over 10 min, not to exceed 50 mg. Establish dose based on blood coagulation studies.
Teaching points
  • This drug must be given by a parenteral route (cannot be taken orally).
  • Frequent blood tests are necessary to determine blood clotting time is within the correct range.
  • Be careful to avoid injury: Use an electric razor, avoid contact sports and other activities that might lead to injury.
  • You may experience loss of hair.
  • Report nose bleed, bleeding of the gums, unusual bruising, black or tarry stools, cloudy or dark urine, abdominal or lower back pain, severe headache.