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/clinical/cckm-tools/content/order-sets/inpatient/cardiologyct-surgery/name-101171-en.cckm

20170494

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100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,Cardiology/CT Surgery

IP - Ventricular Assist Device Anticoagulation - Adult - Supplemental [4999]

IP - Ventricular Assist Device Anticoagulation - Adult - Supplemental [4999] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Cardiology/CT Surgery


IP - Ventricular Assist Device Anticoagulation - Adult - Supplemental [4999]
for Adult Patients OnlyIntended
Patient Care Orders
Vital Signs [145322]
Measure Weight For Dose Calculations
[NURMON0054]
ONCE, Starting today For 1 Occurrences, STAT
Assess For Bleeding Every 8 Hours
[NURMON0060]
SEE COMMENTS, Assess for bleeding every 8
hours.
Anticoagulation Regimens - Select One Only
Adult -ECMO Heparin Anticoagulation -Heparin and ECMO Orders Refer to IP For
Supplemental [5894] Order Set-
5036 Momentum-use the RSH 2015–Heparin Anticoagulation for HeartMate III
operative order set. Do NOT use this order set-Post
URL:
Anticoagulation Regimens - Select One Only (Single Response) [145228]
Heparin Anticoagulation for Anti-Xa goal 0.4-0.8
IU/mL - HeartMate II, HeartWare [145218]
HEPARIN LEVEL BY ANTI-XA [XLMWH] CONDITIONAL - RN COLLECT For 7 Days,
Routine
Is the patient receiving any anticoagulant? Yes
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition? Draw STAT 6 hours
after initiation of heparin infusion and 6 hours after
every heparin dose adjustment
NOTE: No initial heparin bolus [NURCOM0022] ONCE For 1 Occurrences, NOTE: No initial heparin
bolus
heparin 25,000 units in dextrose 5% 500 mL
infusion [51597]
5-20 Units/kg/hr, Intravenous, CONTINUOUS
Initiate at 10 units/kg/hr
Titrate to anti-Xa goal 0.4-0.8 IU/mL
<0.2: inform MD, confirm bolus, and increase
infusion rate by 2 units/kg/hr
0.2-0.39: increase infusion rate by 1 unit/kg/hr
0.4-0.8: no change
0.81-1.0: decrease infusion rate by 1 unit/kg/hr
1.1-1.7: hold infusion for 1 hour and decrease
infusion rate by 2 units/kg/hr
>1.7: inform MD, hold infusion 1.5 hours, and
decrease infusion rate by 3 units/kg/hr
heparin 1000 units/mL vial - Maximum 5000
units/dose [45303]
20 Units/kg, Intravenous, PRN, anti-Xa < 0.2 IU/mL
Maximum 5000 units/dose
Notify Provider [NURCOM0022] CONTINUOUS, Anti-Xa less than 0.2 IU/mL or
greater than 1.7 IU/mL
Heparin Anticoagulation for ACT goal 180-200
seconds & Anti-Xa goal 0.4-0.8 IU/mL -
CentriMag & Tandem Heart (placed by surgeon)
[219313]
ACTIVATED CLOTTING TIME, POC
[HCACTPOC]
EVERY 1 HOUR For 8 Occurrences, Routine
If Conditional, What Condition?
Draw at initiation of heparin infusion then every 1
hour for 5 hours. At 6 hours after initiation of
heparin infusion, begin using Anti-Xa
Page 1 of 4
Printed by LIND, JANNA S [JSL237] at 4/4/2017 10:18:40 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 04/2017CCKM@uwhealth.org

HEPARIN LEVEL BY ANTI-XA [XLMWH] CONDITIONAL - RN COLLECT For 7 Days,
Routine
Is the patient receiving any anticoagulant? Yes
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition? Draw STAT 6 hours
after initiation of heparin infusion and 6 hours after
every heparin dose adjustment
NOTE: No initial heparin bolus [NURCOM0022] ONCE For 1 Occurrences, NOTE: No initial heparin
bolus
heparin 25,000 units in dextrose 5% 500 mL
infusion [51597]
5-20 Units/hr, Intravenous, CONTINUOUS
Initiate at 10 units/kg/hr
FIRST 6 HOURS: Titrate to ACT goal 180-200
seconds
< 180: inform MD, confirm bolus, and increase
infusion rate by 2 units/kg/hr
180 – 200: no change
201 – 250: decrease infusion rate by 2 units/kg/hr
>250: inform MD, hold infusion until ACT < 250
then decrease infusion rate by 3 units/kg/hr
STARTING WHEN FIRST ANTI-XA RESULT IS
AVAILABLE: Titrate to anti-Xa goal 0.4-0.8 IU/mL
<0.2: inform MD, confirm bolus, and increase
infusion rate by 2 units/kg/hr
0.2-0.39: increase infusion rate by 1 unit/kg/hr
0.4-0.8: no change
0.81-1.0: decrease infusion rate by 1 unit/kg/hr
1.1-1.7: hold infusion for 1 hour and decrease
infusion rate by 2 units/kg/hr
>1.7: inform MD, hold infusion 1.5 hours, and
decrease infusion rate by 3 units/kg/hr
Refer to Mechanical Circulatory Device (MCD)
guideline
heparin 1000 units/mL vial - Maximum 5000
units/dose [45303]
20 Units/kg, Intravenous, PRN, ACT<180 seconds
OR anti-Xa<0.2 IU/mL
Maximum 5000 units/dose
Notify Provider [NURCOM0022] CONTINUOUS, ACT less than 180 seconds or
greater than 250 seconds.
Anti-Xa less than 0.2 IU/mL or greater than 1.7
IU/mL
Heparin Anticoagulation for Anti-Xa goal of
0.7-1.0 - Patients with Hemolysis [145220]
HEPARIN LEVEL BY ANTI-XA [XLMWH] CONDITIONAL - RN COLLECT For 7 Days,
Routine
Is the patient receiving any anticoagulant? Yes
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition? Draw STAT 6 hours
after initiation and 6 hours after every heparin dose
adjustment
NOTE: No initial heparin bolus [NURCOM0022] ONCE For 1 Occurrences, NOTE: No initial heparin
bolus
Page 2 of 4
Printed by LIND, JANNA S [JSL237] at 4/4/2017 10:18:40 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 04/2017CCKM@uwhealth.org

heparin 25,000 units in dextrose 5% 500 mL
infusion [51597]
5-20 Units/kg/hr, Intravenous, CONTINUOUS
Initiate at 10 units/kg/hr
Titrate to anti-Xa goal 0.7-1.0 IU/mL
<0.1: inform MD, confirm bolus, increase infusion
rate by 3 units/kg/hr
0.1-0.29: confirm bolus, increase infusion rate by 2
unit/kg/hr
0.3-0.69: increase infusion rate by 1 unit/kg/hr
0.7-1.0: no change
1.1-1.4: decrease infusion rate by 1 unit/kg/hr
1.5-1.7: hold infusion for 1 hour and decrease
infusion rate by 2 units/kg/hr
>1.7: inform MD, hold infusion 1.5 hours and
decrease infusion rate by 3 units/kg/hr
heparin 1000 units/mL vial - Maximum 10,000
units/dose [45303]
40 Units/kg, Intravenous, PRN, anti-Xa < 0.1 IU/mL
Maximum 10,000 units/dose
heparin 1000 units/mL vial - Maximum 5,000
units/dose [45303]
20 Units/kg, Intravenous, PRN, anti-Xa 0.1-0.29
IU/mL
Maximum 5,000 units/dose
Notify Provider [NURCOM0022] CONTINUOUS, Anti-Xa less than 0.1 IU/mL or
greater than 1.7 IU/mL
Bivalirudin Anticoagulation for PTT goal 40-60
seconds. NOTE: Patients allergic to heparin
[210630]
bivalirudin (ANGIOMAX) 250 mg in sodium
chloride 0.9 % infusion [700613]
0.05-0.3 mg/kg/hr, Intravenous, CONTINUOUS
Initiate at 0.1 mg/kg/hr.
Titrate to PTT goal 40-60 seconds.
<40 seconds: inform MD, increase infusion rate by
20% (mg/kg/hr)
40-60: No change
60-80: Decrease infusion rate by 20% (mg/kg/hr)
>80: inform MD, hold infusion for 1 hour and
decrease infusion rate by 50% (mg/kg/hr)
Notify Provider [NURCOM0022] CONTINUOUS, PTT less than 40 or greater than
80 seconds
PTT [PTT] CONDITIONAL - RN COLLECT For 7 Days,
Routine
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition? Draw STAT 2 hours
after every bivalirudin dose adjustment
PTT [PTT] STAT - RN COLLECT For 1 Occurrences, STAT
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
Bivalirudin Anticoagulation for PTT goal 60-80
seconds. NOTE: Patients with hemolysis who
failed heparin therapy [210631]
bivalirudin (ANGIOMAX) 250 mg in sodium
chloride 0.9 % infusion [700613]
0.05-0.3 mg/kg/hr, Intravenous, CONTINUOUS
Initiate at 0.1 mg/kg/hr.
Titrate to PTT goal 60-80 seconds.
<40 seconds: inform MD, increase infusion rate by
20% (mg/kg/hr)
40-60: increase infusion rate by 10% (mg/kg/hr)
60-80: no change
80-100: decrease infusion rate by 20% (mg/kg/hr)
>100: inform MD, hold infusion for 1 hour and
decrease infusion rate by 50% (mg/kg/hr)
Page 3 of 4
Printed by LIND, JANNA S [JSL237] at 4/4/2017 10:18:40 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 04/2017CCKM@uwhealth.org

Notify Provider [NURCOM0022] CONTINUOUS, PTT less than 40 or greater than
100 seconds
PTT [PTT] CONDITIONAL - RN COLLECT For 7 Days,
Routine
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition? Draw STAT 2 hours
after every bivalirudin dose adjustment
PTT [PTT] STAT - RN COLLECT For 1 Occurrences, STAT
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
Laboratory
Draw Now (STAT) [145325]
PROTHROMBIN TIME/INR [PT] STAT - RN COLLECT, Starting today For 1
Occurrences, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
HEMOGLOBIN [HGB] STAT - RN COLLECT, Starting today For 1
Occurrences, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
PLATELET COUNT [PLT] STAT - RN COLLECT, Starting today For 1
Occurrences, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Other [145327]
HEMOGLOBIN [HGB] EVERY OTHER DAY, Starting tomorrow at 5:00 AM
For 14 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
PLATELET COUNT [PLT] EVERY OTHER DAY, Starting tomorrow at 5:00 AM
For 14 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Page 4 of 4
Printed by LIND, JANNA S [JSL237] at 4/4/2017 10:18:40 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 04/2017CCKM@uwhealth.org