Hi all,

I've had several people reach out regarding the publications for our corrected heparin levels, so I figured I would just go ahead and share them here. Please feel free to reach out if you'd like more information - I can do my best to help or can connect you to our hematology pharmacist.

Thanks,
Kara
krp4h@uvahealth.org

Hello all. we have recently had several reports from our Cath lab of patient's requiring high doses of heparin to attain therapeutic ACTs. We have perhaps found a correlation between this and a new heparin product we are stocking > Meitheal Heparin 10,000 units/10 ml vial. We have seen doses reported as high as 24,000 units to attain an ACT > 300. Has anyone else encountered a similar issue recently?

Good afternoon!
My health system uses the Epic platform heparin calculator, and we are currently working to enhance the safety of our process with the calculator. If you use the Epic calculator:
1. What safety concerns have you identified?
2. Were you able to resolve concern(s)?
3. If so, how did you resolve the concern?
Thank you!

Hi all,

Our facility is having a lot of administration errors with heparin drips. We have done tons of education and reminders, but the same mistakes keep happening. We use Epic and it seems the entry is just not nursing friendly. I was wondering if any of you have had the same issues and/or what your heparin entries/builds look like. What mechanisms or procedures do you use to minimize these errors?

The errors include:

Are baseline ACTs checked before heparin administration in your cath lab?
If yes, which of the following apply for checking the baseline ACT?
1. Checked on all patients
2. Checked based on recent heparin administration/infusion
3. Checked based on recent PTT or Hep Quant Assay result (e.g. recent supra-therapeutic PTT)
4. Other?

Thank you for your response,
Stacie Ethington MSN, RN-BC
Medication Safety Nurse Specialist
Nebraska Medicine

How does your org prevent RNs from inadvertently increasing heparin dose after holding for critical PTT when post-hold PTT comes back therapeutic or subtherapeutic?

For example, my org's protocol is that if PTT is critical, hold heparin x 1 hr, recheck PTT, and if less than x secs, restart at 3 units/kg/h less than pre-hold dose. However, if post-hold PTT is subtherapeutic, for example, some RNs may misinterpret the protocol (which has been reviewed by human factors engineer) and increase dose, not as intended.

We have recently switched to monitoring heparin assays for our weight based heparin drips and have had several situations where the heparin assays have remained subtherapeutic despite high doses of heparin (>25units/kg/hr). This has been occurring more in our critical care population. Has anyone encountered the same issue and have any guidance on how to manage ( argatroban vs giving thrombin vs alternative monitoring vs other) thanks.

I would like to network with organizations that have a low number of heparin events and/or have completed work to improve safety surrounding heparin. Our hospital is doing a comprehensive review of our heparin processes. Please contact me if you would be willing to speak concerning heparin. Thank you for your consideration.

Has anyone dealt with the Impella VAD and heparin safety issues? My cards coordinator says it requires a heparin drip autotitrayedby the VAD controller to maintain a certain pressure, and that a separate heparin infusion is run via smart pump to achieve systemic anticoag.

Any experience/insight appreciated -

I work for a 15 hospital system and we are tackling standardizing heparin concentrations used in radiology for peripheral vascular procedures (e.g. catheter directed thromboplysis). The radiologists say that they need dilute heparin so there is sufficient flow rate in addition to the MOA of heparin to prevent pericatheter thrombosis.

My premises to this project:
- Minimize available heparin drip concentrations to 1-2 at most organziation-wide
- Use premixed solutions whenever possible