it is an brief description and slides about the CYANOSIS,ISCHEMIA, ISCHEMIC MANAGEMENT MEANING , HEPARIN , HEPARIN USES , IV INFUSION, SIMPLE HEPARIN IV INFSUION CALUCULATION FORMULAE , ANTIDOTE AND NURSING MANAGEMENT,expalins in diagrammatic manner for nurses, ICU nursing educators,primarily its most benificial for INTENSIVE NURSES works in critical area units like ICUs , CT ICUS etc...
THIS IS AN BRIEF INFORMATION ABOUT AN ONE OF MY FAVOURITE SUBJECT ARDS & & ITS MANAGEMENT ,ROLES OF INTENSIVE NURSES , IT WILL EXPLAINS ABOUT CATEGORIES, PF RATIO, PRONE POSITIONING & NURSING CARE .....FOR THIS I REFFERED OLD SLIDE SHARE PPTS & IN HOSPITAL ROUTINELY PRACTICING POLICIES
Mechanical ventilator, common modes, indications,nursing responsibilities MURUGESHHJ
it is an brief summary with diagrammatic presentation for NURSES regarding Mechanical ventilator, uses, complications, types, important terms,common modes, NIV, uses, NURING ROLES & RESPONSIBILITIES for handling INTUBATED patients...
Caring patient on Mechanical Ventilator Shanta Peter
Mechanical ventilators are used now in general wards , not only in ICU -to save patient's life. We need to care patient and ventilator while working with it ..
THIS IS AN BRIEF INFORMATION ABOUT AN ONE OF MY FAVOURITE SUBJECT ARDS & & ITS MANAGEMENT ,ROLES OF INTENSIVE NURSES , IT WILL EXPLAINS ABOUT CATEGORIES, PF RATIO, PRONE POSITIONING & NURSING CARE .....FOR THIS I REFFERED OLD SLIDE SHARE PPTS & IN HOSPITAL ROUTINELY PRACTICING POLICIES
Mechanical ventilator, common modes, indications,nursing responsibilities MURUGESHHJ
it is an brief summary with diagrammatic presentation for NURSES regarding Mechanical ventilator, uses, complications, types, important terms,common modes, NIV, uses, NURING ROLES & RESPONSIBILITIES for handling INTUBATED patients...
Caring patient on Mechanical Ventilator Shanta Peter
Mechanical ventilators are used now in general wards , not only in ICU -to save patient's life. We need to care patient and ventilator while working with it ..
The use of algorithms & emergency boxes in obstetric emergencyWafaa Benjamin
obstetric hemorrhage Is the major cause of maternal mortality globally.
Substandard management identified as a contributor for maternal mortality in UK in 80% of the cases.
Is the major cause of mortality in Egypt ,according to the last Egyptian Maternal Mortality Report in 2001.
So we need to Work in a team, Do all needed steps, In the proper sequence of the steps,
competent emergency team should have Knowledge ,Skills , Attitude & exposed to regular Labor Ward drills.
Ready available Algorithms & Emergency Boxes are found to be helpful in emergency situations.
I am professionally pharmacist. These slides for clinical subject especially for pharmacy department students. I hope these students get more benefits about it.
EXTERNAL VENTRICULAR CARE FOR NURSES.pptxMURUGESHHJ
EVD---EVD CARE ESPECAILLY IN ICU SETTINGS MORE ESSENTIAL , THIS PPT EXPLAINS YOU ABOUT EVD IN BRIEF, INDICATIONS, COMPLICATIONS , , EVD CARE PROCEDURE, NURSING DIAGNOSIS & MANGEMENT ASSOCIETED WITH EVD RELATED INFECTIONS ...
HOSPTAL ACQUIRED PNEUMONIAE , PREVENTION AND MANAGEMENT PROTOCALS MURUGESH.pptxMURUGESHHJ
this is an brief explanation for one of most common infection in hospital i.e , HAI, meaning, causes, prevention & management stragies , VAP OR VAE & NVHAP bundles, especially usefull for nurses ...
IMPORTANCE OF ORAL CARE IN ICU MURUGESH HJ.pptxMURUGESHHJ
THIS PPT EXPLAINS ABOUT IMPORTANCE OF ORAL HYGIENE ESPECIALLY FOR UNCONSIOUS PATIENTS, SEVERLY ILL PATIENTS , IT EXPLAINS YOU ABOUT PROCEDURE, IMPORTANT ARTICLES , MOST BENEFICIAL FOR NURSES
HEART SOUNDS ASSESSMENT FOR NURSES MURUGESH.pptxMURUGESHHJ
IT IS AN BRIEF DESCRIPTION ABOUT SIMPLE ASSESMENT OF HEART , ANATOMY & PHYSIOLOGY OF HEART ,HEART SOUNDS, NORMAL & ABNORMAL SOUNDS..ESPECIALLY MOST USEFULL TO NURSES...
Neuroassessment important neuro reflex’s in icu for nurses +rass score+tbiMURUGESHHJ
its an small guide to assess the neuorological status with various pictures , it explains clearly about GCS, MUSCULAR POWER ASSESSMENT , PUPILLARY REACTION & IMPORTANT REFLEXES specially for nurses ....it has brief information about TBI PROTOCAL & RASS SCORE
Chest auscultation & lung sounds assessment for nursesMURUGESHHJ
its an brief explanation regarding respiratory system & most common sites to assess lung sounds &lobe associated lung infections...visuals explains briefly & clearly about abnormal lung conditions
Artereal blood gas meaning,brief guide for nurses murugeshMURUGESHHJ
ABG-It is an vital &fastest test to assess the patient haemodynamics , this ppt explains you briefly about ABG meaning, components,sampling, allens test & nurses roles....
Diabetic ketoacidosis meaning,types &management for nurses murugeshMURUGESHHJ
its an brief information about the Diabetic ketoacidosis, causes, signs & symptoms ,hospital management protocals in simple english......provides more information with diagrammatic way ...thank you all
its an brief information for Intensive nurses about the Neurological assessment ,GCS, braian death assessment & expalins about important brain reflex's pertaining to icu setup, for making this pdf i used out hospitlas protocal, nursing journals.....
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
1. CYANOSIS , HEPARIN IV
INFUSION,IV
CALUCULATION
FORMULAE,NURSING
MANAGEMENT
PREPARED BY
MURUGESH HJ RN.
ICU 02 ( HAYATH) , KFCH HOSPITAL JIZAN , SAUDI ARABIA
2. CIRCULATORY SYSTEM…
The circulatory system, also called the cardiovascular system or the vascular
system, is an organ system that permits blood to circulate and
transport nutrients (such as amino acids and electrolytes), oxygen, carbon
dioxide, hormones, and blood cells to and from the cells in the body to provide
nourishment and help in fighting diseases, stabilize temperature and pH, and
maintain homeostasis.
The cardiovascular (from Latin words meaning "heart" and "vessel") system
comprises the BLOOD, HEART & BLOOD VESSELS…
THERE IS TWO MAIN TYPES OF CIRCULATION
1.SYSTEMIC CIRCULATION
2.GENERAL CIRCULATION..
3. IMPORTANT TERMS….
HOMEOSTASIS- ITS AN STATE OF EQUILIBRIUM BETWEEN ALL THE SYSTEMS WORKS
NORMALLY , PERSON WILL BE HEALTHY…
VASCULAR DISEASES -DISEASES PERTAINING TO CIRCULATORY SYSTEM, LIFE THRETNING
WITH HIGH AFFINITY TO DISABILITY OR MORTALITY..
The most common vascular diseases are stroke, peripheral artery disease (PAD), abdominal
aortic aneurysm (AAA), carotid artery disease (CAD), arteriovenous malformation (AVM),
critical limb-threatening ischemia (CLTI), pulmonary embolism (blood clots), deep vein
thrombosis (DVT), chronic venous insufficiency (CVI), and varicose veins…In this cases there
should be strict close monitoring required for HAEMOSTATITICS( LAB VALUES)
eg: Coagulation profile, platelet count, etc….
4. IMPORTANT ABREVIATIONS,,,,,
CYANOSIS-Cyanosis refers to a bluish-purple hue to the skin. It is most easily seen
where the skin is thin, such as the lips, mouth, earlobes and fingernails. Cyanosis
indicates there may be decreased oxygen attached to red blood cells in the
bloodstream. It may suggest a problem with the lungs or heart.
ISCHEMIA-Ischemia is a condition in which the blood flow (and thus oxygen) is
restricted or reduced in a part of the body. Example; cardiac ischemia is the name for
decreased blood flow and oxygen to the heart muscle…
NECROSIS-Necrosis is the death of body tissue. It occurs when too little blood flows to
the tissue. This can be from injury, radiation, or chemicals. Necrosis cannot be
reversed. When large areas of tissue die due to a lack of blood supply, the condition is
called gangrene.
5. IMPORTANT ABREVIATIONS,,,,,
APOPTOSIS-Apoptosis is the process of programmed cell death. It is used during early
development to eliminate unwanted cells; for example, those between the fingers of a
developing hand. In adults, apoptosis is used to rid the body of cells that have been damaged
beyond repair. Apoptosis also plays a role in preventing cancer.
THROMBECTOMY- SURGICAL REMOVAL OF THROMBUS( CLOTS)
ANTICOAGULANTS-Anticoagulants, or blood thinners, and thrombolytics are medicines
commonly used to treat VTE. Anticoagulants, or blood thinners, keep blood clots from getting
larger and stop new clots from forming. Conventional blood thinners include warfarin and
heparin
EXAMPLES- Warfarin,Apixaban,Dabigatran,Rivaroxaban,Apixaban,
and,Edoxaban etc……
6. HEPARIN IV INFUSION…..
HEPARIN IV INFUSION-Unfractionated heparin (UFH) is a mixture of sulfated
glycosaminoglycans, some of which possess anticoagulant properties. It is rapidly removed from
the body with a half-life of 30 to 60 minutes, however the half-life may increase with increasing
dosage or in renal impairment. Due to this short half-life it must be given by continuous
intravenous infusion with monitoring of APTT and appropriate dosage adjustments for
conditions requiring full anticoagulation…..
PRECAUTIONS while giving heparin ( POINTS TO BE KEEP IN MIND)
▪ Thrombocytopenia –
▪ Severe uncontrolled hypertension (BP greater than 200/120) – use with great care.
▪ Intrathecal or epidural analgesia or anaesthesia, or lumbar puncture –at risk of epidural
haematoma which can cause paralysis. ______________________________________________________
7. INDICATIONS FOR HEPARIN INFUSION..
INDICATIONS-
Heparin sodium is indicated for:
• Prophylaxis and treatment of venous thromboembolism(VTE) and pulmonary
embolism(PE)
• Atrial fibrillation with embolization;
• Treatment of acute and chronic consumptive coagulopathies (disseminated
intravascular coagulation);
• Prevention of clotting in arterial and cardiac surgery;
• Prophylaxis and treatment of peripheral arterial embolism;
• Anticoagulant use in blood transfusions, extracorporeal circulation, and dialysis
procedures.
8. SIDE EFFECTS OF HEPARIN….
What are side effects of Heparin in skin& iv site
Common side effects of Heparin are:
easy bleeding and bruising;
pain, redness, warmth, irritation, or skin changes where the medicine was injected;
itching of your feet; or
bluish-colored skin.
9. HEPARIN IS CONTRA INDICATED IN
FOLLOWING CONDITIONS…
CONTRAINDICATIONS FOR HEPARIN INFSUION…
▪ History of Heparin-induced thrombocytopenia (HIT) –
Renal impairement.
▪ Ongoing full anticoagulation with another agent.
▪ Severe thrombocytopenia (platelets less than 50 x 109/L).
▪ Active bleeding or disease states with an increased risk of bleeding.
▪ History of haemorrhagic stroke.
▪ Recent large thromboembolic stroke.
▪ Severe hepatic disease or impairment (with elevated INR), including oesophageal varices.
▪ Subacute or acute bacterial endocarditiS
10. METHOD FOR IV HEPARIN
CALCULATION
METHOD FOR IV HEPARIN CALCULATION
FARMULA 01
The following method of calculation is to be used when calculating Heparin doses:
Total Units of Heparin = Units/hour
Total Amount of infusion (mLs) mLs/hour
****adjust from the current dose not from the initial dose..
****increase or decrease it should be based on LAB APTT VALUE….
**** INFUSION NEED TO START WITH 80UNITS/KG IV STAT BOLUS, LATER ACCORDING HEPARIN IV
INFUSION PROTOCAL…
Increase by 2units /kg======2X 80KG=160UNITS, Eg: 1440units+160units=1600units/hr……
Decrease by 2units /kg =====2x 80KG=160units Eg: 1440units-160units=1280units/hr …..
11. INITAIL DOSE CALUCULATION
SIMPLE CALUCULATIONS FOR INITIAL DOSE 80UNITS/KG IV STAT BOLUS……
HEAPARIN 1AMPOULE =25,000UNITS IN 500ML NSS IT MEANS 250000/500 = 50UNITS I mean 1ml = 50units ….
80units/KG IV STAT BOLUS MEANS , Example patient weight is 60kg , TOTAL STRENGTH 25000UNITS,SOLUTION IS 500ML
FORMULA IS
Total Units of Heparin = Units/hour
Total Amount of infusion (mLs) mLs/hour
25,000/500=4800/X
50=4800X
X=4800/50
X=97.6ml
12. EXAMPLE….
EXAMPLE:
Order: Heparin 1400 units q hour IV
Standard Solution 25,000 units of Heparin in 500 mL D5W
How many mLs/hr will you administer
25,000 total units of Heparin = 1400 units/hr
500total amount of infusion (mLs) X mLs/hr
25000 = 1400
500 X
50 = 1400
1 X
Cross multiply
50 x = 1400
X=1400/50
X = 28mL/hr
13. HEPARIN CALUCULATION….
FOR IV HEPARIN CALCULATION
FORMULA; 02
HEPARIN DOSE X 500ML ML NSS /25,000UNITS
INITIAL DOSE 80UNITS/KG/IV BOLUS,,
IF PATIENT WEIGHT IS 80KG , SOLUTION IS 500ML NSS, STRENGTH 25,000UNITS
EXAMPLE:
18units X 80KG = 1440UNITS/Hr,,
1440UNITS X 500ML NSS/25000UNITS =28.8ML/Hr
Increase by 2units /kg=2X 80=160UNITS, Eg: 1440units+160units=1600units/hr……
Decrease by 2units /kg =2x 80=160units Eg: 1440units-160units=1280units/hr …..
****adjust from the current dose not from the initial dose..
****increase or decrease it should be based on LAB APTT VALUE….
**** INFUSION NEED TO START WITH 80UNITS/KG IV STAT BOLUS, LATER ACCORDING HEPARIN IV INFUSION PROTOCAL…
15. APTT VALUE IS KEY FOR HEPARIN IV
INFUSION,,,,,,
Laboratory Monitoring: HEPARIN
Activated partial thromboplastin time (aPTT) is used most commonly to determine the most effective
dosage of UFH and other anticoagulants.
Clinically, we are mostly interested in the aPTT to monitor unfractionated heparin therapy.
The aPTT is normally 25 – 35 seconds, but varies from lab to lab. Therapeutic anticoagulation is
determined based upon your patient’s weight. It is often ordered to be maintained at 1.5 to 2.5 times the
upper limit of the normal values (Valentine & Hull, 2012).
Material protected by Copyright
Initially, the aPTT drawn prior to initiation, four to six hours after initiation of heparin, & four to six hours
after a dose change. When the aPTT is within a therapeutic range for your patient’s weight and disease
process, the frequency of testing is decreased, usually to every 12-24 hours per hospital protocol.
Because UFH therapy causes different responses in different patients, the aPTT must be monitored
during heparin therapy to monitor the effects of heparin.
16. Management of Heparin
Overdose..PROTAMINE
Management of Heparin Overdose
Protamine sulfate works to reverse heparin induced bleeding by binding to heparin ions to block
anticoagulant activity.
It can be administered in a slow intravenous infusion (not greater than 20mg/min and no more than
50mg over any 10 minute period).
The appropriate dose of protamine sulfate is dependent upon the dose of heparin given and the
elapsed time since the last heparin dose.
Full neutralization of heparin effect is achieved with a dose of 1mg protamine sulfate/100units of
heparin. Dose varies with heparin dose and time elapsed since administration of heparin.
If heparin had been given by subcutaneous injection, repeated small doses of protamine may be
required because of prolonged heparin absorption from the various subcutaneous sites.
(Valentine & Hull, 2011)
17. NURSING RESPONSIBILITIES….
Avoiding Heparin Errors…..
Tips to avoid heparin associated errors include:
• Have another nurse double check all of your heparin calculations independently prior to the
administration of the heparin.
• Ask another nurse to. verify the right drug, right dose, the right client (with two identifiers), the
right route, right documentation, and the right time
• If multi-dose supplies of heparin are still available on your nursing unit, ask your nurse manager
to check into having single dose supplies ordered instead.
• Never rely on the color of a label or it being located in a familiar place. Always read the label on
the vial, and check this against the order.
• Always get another nurse to review your orders if unclear.
• When unsure about a particular dose, always check with the physician and/or pharmacy.
• Know the normal doses for your patients.
18. Cont…
***Watch for bleeding , changes in vital signs , neuro observation, LAB values..
***obtain the blood sample from the non IV CANULLATED hand, ;avoid sample
errors…
***assess skin for bruising, any minute bleeding….
19. References….
Reference
1. Lackie CL, Luzier AB, Donovan JA, Feras HI, Forrest A. Weight-based heparin dosing: clinical response
and resource utilization. Clin Ther. 1998 Jul-Aug;20(4):699-710.
2. Raschke RA, Reilly BM, Guidry JR, Fontana JR, Srinivas S. The weight-based heparin dosing nomogram
compared with a "standard care" nomogram. A randomized controlled trial. Ann Intern Med. 1993 Nov
1;119(9):874-81.
3. Myzienski AE, Lutz MF, Smythe MA. Unfractionated heparin dosing for venous thromboembolism in
morbidly obese patients: case report and review of the literature. Pharmacotherapy. 2010 Mar;30(3):324.
4. Smith ML, Wheeler KE. Weight-based heparin protocol using antifactor Xa monitoring. Am J Health Syst
Pharm. 2010 Mar 1;67(5):371-4. Links / References
CUH IV Heparin prescription chart
CUH IV Heparin policy addendum 20210315
How to Anticoagulation. Drug and Therapeutics Bulletin 1992; 30: 77-80
St Vincents University Hospital. Procedure to standardise management of SVUH patients on an unfractionated heparin infusion. Version 06 – 13-03-2009.
Guy’s and St Thomas’ NHS Foundation Trust. Clinical Guideline. Adult guidelines for Unfractionated Heparin infusions for systemic anticoagulation for APTT 2 – 2.5. Review date 30 May 2015.
