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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.

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