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/clinical/cckm-tools/content/order-sets/inpatient/hospital-wide/name-98279-en.cckm

20170494

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UWHC,UWMF,

Tools,

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

IP - ECMO Heparin Anticoagulation - Adult - Supplemental [5894]

IP - ECMO Heparin Anticoagulation - Adult - Supplemental [5894] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Hospital-wide


IP - ECMO Heparin Anticoagulation - Adult - Supplemental [5894]
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
Unfractionated Heparin in ECMO Guidelines for
Adults
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/hematology-and-
coagulation/name-97534-en.cckm
Standard Bleed Risk (Anti-Xa 0.3 - 0.7) [195218]
Standard Bleed Risk [203497] "And" Linked Panel
heparin 87,500 units in dextrose 5% 250 mL
[700640]
1-60 Units/kg/hr, Intravenous, CONTINUOUS
Initiate at 40 units/kg/hour. For the first 6 hours,
titrate per ECMO ACT anticoagulation algorithim,
then titrate per ECMO standard bleed risk
anticoagulation algorithm after the first anti-Xa level
is resulted.
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
Notify Provider [NURCOM0022] CONTINUOUS, Notify Provider if anti-Xa is less
than 0.2 or greater than 1.7
High Bleed Risk (Anti-Xa 0.2 - 0.4) [195217]
High Bleed Risk [201743] "And" Linked Panel
heparin 87,500 units in dextrose 5% 250 mL
[700640]
1-60 Units/kg/hr, Intravenous, CONTINUOUS
Initiate at 20 units/kg/hour. For the first 6 hours,
titrate per ECMO ACT anticoagulation algorithim,
then titrate per ECMO high bleed risk
anticoagulation algorithm after the first anti-Xa level
is resulted.
Note: No Initial Heparin Bolus [950018] ONCE
Notify Provider [NURCOM0022] CONTINUOUS, Notify Provider if anti-Xa is less
than 0.1 or greater than 1
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
Page 1 of 2
Printed by LIND, JANNA S [JSL237] at 4/4/2017 10:30:51 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 04/2017CCKM@uwhealth.org

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 2 of 2
Printed by LIND, JANNA S [JSL237] at 4/4/2017 10:30:51 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 04/2017CCKM@uwhealth.org