# Do you give another bolus, and if yes, how much do you give?

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Your patient weighs 96 lb. The doctor orders Heparin for the patient, a bolus of 60 units/kg to be pushed over 5 minutes and an infusion to run 14 units/kg/hr. You have Heparin Sodium with a concentration of 800 units/mL available for the bolus. For the infusion you have bags with 25,000 units of Heparin in 1000 mL D5W.

In addition, every six hours the patient’s blood will be tested for clotting time, and the aPTT result will be determined. Here is the heparin protocol to be used.

 aPTT Result Bolus Dose Hold time (min) for Infusion Change to Infusion Rate Less than 55 15 units/kg No hold Increase 4 units/kg/hr 55-69 10 units/kg No hold Increase 2 units/kg/hr 70-79 5 units/kg No hold Increase 1 unit/kg/hr 80-100 No bolus given No hold No Change 101-110 No bolus given No hold Decrease 1 unit/kg/hr 111-120 No bolus given 30 Decrease 2 unit/kg/hr 121-140 No bolus given 60 Decrease 3 units/kg/hr More than 140 No bolus given 90 Decrease 5 units/g/hr

Question: (15 points) Six hours later, the patient’s blood is tested and returns an aPTT result of 58. Do you give another bolus, and if yes, how much do you give? Do you change the infusion rate? If yes, what is the new rate?

From the table: 55-69 , bolus dosage  = 10 units/kg , Change infusion rate by : Increase 2 units/kg/hr.

Units to infuse = 43.6 kg * 10 units/kg = 436 units.

Bolus to pus = 436 units.

Available to push = 800 units/mL

436 units ~ 0.55 mL

Push rate = 0.55 mL/5 min = 0.11 mL/min.

Push rate mL/15 s =  15 s * 0.11 mL/60 s =  0.03 mL/S.

The Infusion rate changes to 16 units/kg/hr.

Infusion rate  = (43.6 kg * 16 units/kg)/hr =  698 units/hr

Rate  = 27.9 mL/hr.