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

IP - ECMO Heparin Anticoagulation - Pediatric - Supplemental [5816]

IP - ECMO Heparin Anticoagulation - Pediatric - Supplemental [5816] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Hospital-wide


IP - ECMO Heparin Anticoagulation - Pediatrics - Supplemental [5816]
Patient Care Orders
Patient Monitoring [195213]
Measure Weight For Dose Calculations [NURMON0054] ONCE For 1 Occurrences, Routine
Assess for Bleeding Every 8 Hours [NURMON0050] EVERY 8 HOURS, Routine, Assess for Bleeding Every 8
Hours - Hemoglobin decreases by more than 2 g/dL from
baseline, Platelet Count decreases by more than 1/3 of
baseline value, Any sign of bleeding, Any deterioration in
neurological status.
Medications
Standard Bleed Risk (Anti-Xa 0.3-0.7) [198803]
For patients weighing less than 10 kg [201729] "And" Linked Panel
heparin 12,500 units in dextrose 10% 250 mL [700640] 40 Units/kg/hr, Intravenous, CONTINUOUS
Initiate at 40 units/kg/hour. For the first 6 hours, titrate per
ACT levels, then titrate based on anti-Xa levels after the
first anti-Xa level is resulted. Contact the provider
responsible for the heparin infusion after each lab result
(ACT or anti-Xa) for infusion titration orders.
heparin 1000 unit/mL 10mL vial STOCK VIAL -
Maximum Dose = 10,000 units [790024]
100 Units/kg, Intravenous, ONCE For 1 Doses
Initial Bolus. Maximum 10,000 units/dose. Do not give
without physician approval.
heparin 1000 unit/mL 10mL vial STOCK VIAL -
Maximum Dose = 5000 units [790024]
40 Units/kg, Intravenous, PRN, anti-Xa <0.1
anti-Xa <0.1. Maximum 5,000 units/dose. Do not give
without physician approval.
heparin 1000 unit/mL 10mL vial STOCK VIAL- Maximum
Dose = 2500 units [790024]
20 Units/kg, Intravenous, PRN, anti-Xa 0.1-0.19
anti-Xa 0.1-0.19. Maximum 2,500 units/dose. Do not give
without physician approval.
For patients weighing 10-25.9 kg [201730] "And" Linked Panel
heparin 30,000 units in dextrose 5% 250 mL [700640] 40 Units/kg/hr, Intravenous, CONTINUOUS
Initiate at 40 units/kg/hour. For the first 6 hours, titrate per
ACT levels, then titrate based on anti-Xa levels after the
first anti-Xa level is resulted. Contact the provider
responsible for the heparin infusion after each lab result
(ACT or anti-Xa) for infusion titration orders.
heparin 1000 unit/mL 10mL vial STOCK VIAL -
Maximum Dose = 10,000 units [790024]
100 Units/kg, Intravenous, ONCE For 1 Doses
Initial Bolus. Maximum 10,000 units/dose. Do not give
without physician approval.
heparin 1000 unit/mL 10mL vial STOCK VIAL -
Maximum Dose = 5000 units [790024]
40 Units/kg, Intravenous, PRN, anti-Xa <0.1
anti-Xa <0.1. Maximum 5,000 units/dose. Do not give
without physician approval.
heparin 1000 unit/mL 10mL vial STOCK VIAL -
Maximum Dose = 2500 units [790024]
20 Units/kg, Intravenous, PRN, anti-Xa 0.1-0.19
anti-Xa 0.1-0.19. Maximum 2,500 units/dose. Do not give
without physician approval.
For patients weighing 26-49.9 kg [201731] "And" Linked Panel
heparin 62,500 units in dextrose 5% 250 mL [700640] 40 Units/kg/hr, Intravenous, CONTINUOUS
Initiate at 40 units/kg/hour. For the first 6 hours, titrate per
ACT levels, then titrate based on anti-Xa levels after the
first anti-Xa level is resulted. Contact the provider
responsible for the heparin infusion after each lab result
(ACT or anti-Xa) for infusion titration orders.
heparin 1000 unit/mL 10mL vial STOCK VIAL -
Maximum Dose - 10,000 units [790024]
100 Units/kg, Intravenous, ONCE For 1 Doses
Initial Bolus. Maximum 10,000 units/dose. Do not give
without physician approval.
heparin 1000 unit/mL 10mL vial STOCK VIAL -
Maximum Dose = 5000 units [790024]
40 Units/kg, Intravenous, PRN, anti-Xa <0.1
anti-Xa <0.1. Maximum 5,000 units/dose. Do not give
without physician approval.
heparin 1000 unit/mL 10mL vial STOCK VIAL -
Maximum Dose = 2500 units [790024]
20 Units/kg, Intravenous, PRN, anti-Xa 0.1-0.19
anti-Xa 0.1-0.19. Maximum 2,500 units/dose. Do not give
without physician approval.
Page 1 of 3
Printed by LIND, JANNA S [JSL237] at 5/31/2016 1:16:37 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 05/2016CCKM@uwhealth.org

For patients weighing 50 kg or greater [201733] "And" Linked Panel
heparin 87,500 units in dextrose 5% 250 mL [700640] 40 Units/kg/hr, Intravenous, CONTINUOUS
Initiate at 40 units/kg/hour. For the first 6 hours, titrate per
ACT levels, then titrate based on anti-Xa levels after the
first anti-Xa level is resulted. Contact the provider
responsible for the heparin infusion after each lab result
(ACT or anti-Xa) for
infusion titration orders.
heparin 1000 unit/mL 10mL vial STOCK VIAL -
Maximum dose = 10,000 units [790024]
100 Units/kg, Intravenous, ONCE For 1 Doses
Initial Bolus. Maximum 10,000 units/dose. Do not give
without physician approval.
heparin 1000 unit/mL 10mL vial STOCK VIAL -
Maximum Dose = 5000 units [790024]
40 Units/kg, Intravenous, PRN, anti-Xa <0.1
anti-Xa <0.1. Maximum 5,000 units/dose. Do not give
without physician approval.
heparin 1000 unit/mL 10mL vial STOCK VIAL - Maximu
Dose = 2500 units [790024]
20 Units/kg, Intravenous, PRN, anti-Xa 0.1-0.19
anti-Xa 0.1-0.19. Maximum 2,500 units/dose. Do not give
without physician approval.
High Bleed Risk (Anti-Xa 0.2-0.4) [198809]
For patients weighing less than 10 kg [202366] "And" Linked Panel
heparin 12,500 units in dextrose 10% 250 mL [700640] 40 Units/kg/hr, Intravenous, CONTINUOUS
Initiate at 40 units/kg/hour. For the first 6 hours, titrate per
ACT levels, then titrate based on anti-Xa levels after the
first anti-Xa level is resulted. Contact the provider
responsible for the heparin infusion after each lab result
(ACT or anti-Xa) for infusion titration orders.
heparin 1000 unit/mL 10mL vial STOCK VIAL -
Maximum Dose = 2500 units [790024]
20 Units/kg, Intravenous, PRN, anti-Xa 0.1-0.19
anti-Xa 0.1-0.19. Maximum 2,500 units/dose. Do not give
without physician approval.
Note: No Initial Heparin Bolus [950018] ONCE
For patients weighing 10-25.9 kg [202369] "And" Linked Panel
heparin 30,000 units in dextrose 5% 250 mL [700640] 40 Units/kg/hr, Intravenous, CONTINUOUS
Initiate at 40 units/kg/hour. For the first 6 hours, titrate per
ACT levels, then titrate based on anti-Xa levels after the
first anti-Xa level is resulted. Contact the provider
responsible for the heparin infusion after each lab result
(ACT or anti-Xa) for infusion titration orders.
heparin 1000 unit/mL 10mL vial STOCK VIAL -
Maximum Dose = 2500 units [790024]
20 Units/kg, Intravenous, PRN, anti-Xa 0.1-0.19
anti-Xa 0.1-0.19. Maximum 2,500 units/dose. Do not give
without physician approval.
Note: No Initial Heparin Bolus [950018] ONCE
For patients weighing 26-49.9 kg [202372] "And" Linked Panel
heparin 62,500 units in dextrose 5% 250 mL [700640] 40 Units/kg/hr, Intravenous, CONTINUOUS
Initiate at 40 units/kg/hour. For the first 6 hours, titrate per
ACT levels, then titrate based on anti-Xa levels after the
first anti-Xa level is resulted. Contact the provider
responsible for the heparin infusion after each lab result
(ACT or anti-Xa) for infusion titration orders.
heparin 1000 unit/mL 10mL vial STOCK VIAL -
Maximum Dose = 2500 units [790024]
20 Units/kg, Intravenous, PRN, anti-Xa 0.1-0.19
anti-Xa 0.1-0.19. Maximum 2,500 units/dose. Do not give
without physician approval.
Note: No Initial Heparin Bolus [950018] ONCE
For patients weighing 50 kg or greater [202375] "And" Linked Panel
heparin 87,500 units in dextrose 5% 250 mL [700640] 40 Units/kg/hr, Intravenous, CONTINUOUS
Initiate at 40 units/kg/hour. For the first 6 hours, titrate per
ACT levels, then titrate based on anti-Xa levels after the
first anti-Xa level is resulted. Contact the provider
responsible for the heparin infusion after each lab result
(ACT or anti-Xa) for infusion titration orders
heparin 1000 unit/mL 10mL vial STOCK VIAL -
Maximum Dose = 2500 units [790024]
20 Units/kg, Intravenous, PRN, anti-Xa 0.1-0.19
anti-Xa 0.1-0.19. Maximum 2,500 units/dose. Do not give
without physician approval.
Page 2 of 3
Printed by LIND, JANNA S [JSL237] at 5/31/2016 1:16:37 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 05/2016CCKM@uwhealth.org

Note: No Initial Heparin Bolus [950018] ONCE
Laboratory
Draw Now (Stat) if not already available [195214]
PROTHROMBIN TIME/INR [PT] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
STAT now for baseline
ACTIVATED CLOTTING TIME, POC [HCACTPOC] STAT - RN COLLECT For 1 Occurrences, Routine
If Conditional, What Condition?
STAT now for baseline
CBC WITHOUT DIFFERENTIAL [HEMO] STAT - RN COLLECT For 1 Occurrences, Routine
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 - RN COLLECT For 1 Occurrences, Routine
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 [195215]
ACTIVATED CLOTTING TIME, POC [HCACTPOC] CONDITIONAL For 7 Days, Routine
If Conditional, What Condition? Draw Every Hour for the first
6 hours or until the first anti-Xa level is resulted
Drawn by ECMO specialist
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 every 6 hours
while on ECMO heparin infusion and after every heparin dose
adjustment
Clinical Monitoring Parameters [195216]
PROTHROMBIN TIME/INR [PT] NEXT AM, Starting tomorrow For 7 Days, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Page 3 of 3
Printed by LIND, JANNA S [JSL237] at 5/31/2016 1:16:37 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 05/2016CCKM@uwhealth.org