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/clinical/cckm-tools/content/order-sets/inpatient/hospital-wide/name-98255-en.cckm

201711325

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,Hospital-wide

IP/ED - Heparin Anticoagulation - Adult - Supplemental [4373]

IP/ED - Heparin Anticoagulation - Adult - Supplemental [4373] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Hospital-wide


IP/ED - Heparin Anticoagulation - Adult - Supplemental [4373]
for Adult Patients OnlyIntended
Patient Care Orders
Vital Signs [17760]
Measure Weight For Dose Calculations
[NURMON0054]
ONCE, Starting today For 1 Occurrences, STAT
Assess For Bleeding Every 8 Hours
[NURMON0060]
SEE COMMENTS, Starting today with First
Occurrence As Scheduled, Assess for bleeding every
8 hours.
Medications
UWHC Unfractionated Heparin Guidelines URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/hematology-and-
coagulation/name-97525-en.cckm
Anticoagulation Regimens - Select One Only Based on Indication (Single Response) [116387]
Pts treated with Alteplase, New Mechanical
Valves (place during current admission), High
bleeding risk (recent surgery, trauma, hepatic
dysfunction) [239641]
Note: NO initial heparin bolus [950018] ONCE For 1 Doses
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 12 units/kg/hr. Titrate per GRADUAL
anticoagulation algorithm
heparin 1000 Units/mL injection [45303] 20 Units/kg, Intravenous, PRN, Anti-Xa < 0.1
Anti-Xa < 0.1
Maximum 5,000 units/dose
Notify Provider [NURCOM0001] Provider to Notify: Provider
Notify based on: Other
Other: anti-Xa less than 0.1 or greater than
1.7,Hemoglobin decreases by more than 2 g/dL from
baseline,Baseline INR greater than 1.2,Platelet
count less than 100 K/uL,Platelet count decreases
by more than 1/3 of baseline value,Any sign of
bleeding,Any deterioration in neurological status
DVT, PE, Ventricular/Atrial Thrombus, or other
indications for Therapeutic Anticoagulation
[239597]
heparin 1000 Units/mL injection [45303] 80 Units/kg, Intravenous, ONCE For 1 Doses
Initial bolus maximum 10,000 units
heparin 25,000 units in dextrose 5% 500 mL
infusion [51597]
5-20 Units/kg/hr, Intravenous, CONTINUOUS
Initiate at 18 units/kg/hr.Titrate per RAPID
anticoagulation algorithm nomogram.
heparin 1000 Units/mL injection [45303] 40 Units/kg, Intravenous, PRN, Anti-Xa less than 0.1
Maximum 10,000 units/dose
heparin 1000 Units/mL injection [45303] 20 Units/kg, Intravenous, PRN, Anti-Xa between
0.1-0.19
Maximum 5000 units/dose
Notify Provider [NURCOM0001] Provider to Notify: Provider
Notify based on: Other
Other: anti-Xa less than 0.1 or greater than 1.7
Acute Coronary Syndrome (WITHOUT Iib/IIIa
inhibitor) [239602]
heparin 1000 Units/mL injection [45303] 60 Units/kg, Intravenous, ONCE For 1 Doses
Initial bolus maximum 4,000 units
Page 1 of 3
Printed by LIND, JANNA S [JSL237] at 11/21/2017 11:28:37 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

heparin 25,000 units in dextrose 5% 500 mL
infusion [51597]
5-20 Units/kg/hr, Intravenous, CONTINUOUS
Initiate at 12 units/kg/hr (maximum rate 1000
units/hour) and titrate per rapid nomogram.
heparin 1000 Units/mL injection [45303] 40 Units/kg, Intravenous, PRN, aPTT less than 35
seconds or anti-Xa less than 0.1
Maximum 10,000 units/dose
heparin 1000 Units/mL injection [45303] 20 Units/kg, Intravenous, PRN, aPTT between 35-38
seconds or anti-Xa between 0.1-0.19
Maximum 5000 units/dose
Notify Provider [NURCOM0001] Provider to Notify: Provider
Notify based on: Other
Other: Baseline aPTT greater than 34 seconds,aPTT
less than 35 or greater than 90 seconds,anti-Xa less
than 0.1 or greater than 1.7,Hemoglobin decreases
by more than 2 g/dL from baseline,Baseline INR
greater than 1.2,Platelet count less than 100
K/uL,Platelet count decreases by more than 1/3 of
baseline value,Any sign of bleeding,Any
deterioration in neurological status
Acute Coronary Syndromes (WITH a IIb/IIIa
inhibitor) [239644]
Note: NO initial heparin bolus [950018] ONCE For 1 Doses
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 12 units/kg/hr. Titrate to anti-Xa goal: 0.1 -
0.3
< 0.1: inform MD, bolus 20 units/kg and increase
infusion rate by 3 units/kg/hr
0.1-0.3: no change
0.31-0.5: decrease infusion rate by 1 unit/kg/hr
0.51-0.8: decrease infusion rate by 2 units/kg/hr
>0.8: Inform MD, hold infusion by 1 hour and
decrease infusion rate by 3 units/kg/hr
Maximum Rate 1000 units/hr
heparin 1000 Units/mL injection [45303] 20 Units/kg, Intravenous, PRN, anti-Xa <0.1
Maximum 5,000 units/dose
Notify Provider [NURCOM0001] Provider to Notify: Provider
Notify based on: Other
Other: anti-Xa less than 0.1 or greater than
0.8,Hemoglobin decreases by more than 2 g/dL from
baseline,Baseline INR greater than 1.2,Platelet
count less than 100 K/uL,Platelet count decreases
by more than 1/3 of baseline value,Any sign of
bleeding,Any deterioration in neurological status
Non-Titration Heparin Infusion Panel [199993]
heparin 25,000 units in dextrose 5% 500 mL
infusion [51597]
500 Units/hr, Intravenous, CONTINUOUS
PLATELET COUNT [PLT] CONDITIONAL For Until specified, Routine
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition? 24 hours post
infusion, and then every 48 hours
24 hours post infusion, and then every 48 hours
Page 2 of 3
Printed by LIND, JANNA S [JSL237] at 11/21/2017 11:28:37 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

HEPARIN LEVEL BY ANTI-XA [XLMWH] EVERY 24 HOURS, Routine
Is the patient receiving any anticoagulant? Yes
(Heparin)
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
Laboratory
Draw Now (STAT) [19998]
PROTHROMBIN TIME/INR [PT] STAT, 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?
STAT now for baseline.
HEMOGLOBIN [HGB] STAT, 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?
STAT now for baseline.
PLATELET COUNT [PLT] STAT, 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?
STAT now for baseline.
Heparin Monitoring (Single Response) [116395]
HEPARIN LEVEL BY ANTI-XA [XLMWH] CONDITIONAL, Starting today For 7 Days, Routine
Is the patient receiving any anticoagulant? Yes
(Heparin)
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
Every Other Day [116394]
HEMOGLOBIN [HGB] EVERY OTHER DAY, Starting tomorrow at 5:00 AM
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 with AM Labs
PLATELET COUNT [PLT] EVERY OTHER DAY, Starting tomorrow at 5:00 AM
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 with AM Labs
Page 3 of 3
Printed by LIND, JANNA S [JSL237] at 11/21/2017 11:28:37 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org