Description and
indication for use
Heparin is used for systemic anti-coagulation and to
manage venous thromboembolism
after discussion with a paediatric haematologist. It is also used to maintain central venous catheters and arterial
line patency.
Heparin
has
little thrombolytic activity and
is generally used to
prevent further clot formation.1
Dose
For systemic anti-coagulation
Low dose treatment:
IV and INF:
Loading
dose 75 units/kg, then 5 to 15 units/kg/hr.
Adjust dose according to clotting times.
SC:
75 units/kg
12 hourly.
Full dose treatment:
IV and INF:
Loading
dose 75 units/kg, then 20 - 40 units/kg/hr.
Adjust according to clotting times.
To maintain patency of umbilical and
peripheral arterial lines
IA:
Babies with current weight
< 2kg: 1 unit/mL (50 units/50
mL) at a rate of 0.5 mL/hr
or for peripheral arterial
line at 1 mL/hr).
Babies with current weight ≥ 2kg: 5 units/mL (250 units/50 mL) at
a rate of 1 mL/hr.
To
maintain patency of central venous catheter (e.g.: long line) if no parenteral
nutrition running
IV:
1 unit/mL
(50 units/50 mL) at a rate of 0.5 mL/hr or 1 mL/hr.
NOTE: 1 mg Protamine
neutralises
approximately 100
units of Heparin.2
Reconstitution/Dilution
Heparin Sodium vial
= 1000 units/mL, 5000 units/0.2 mL, 5000 units/mL.
Heparinised saline ampoule = 50 units/5
mL (10 units/mL).
|
Solution
Concentration
|
Drug
|
Infusion diluent**
|
How to make up
|
|
As prescribed
|
Heparin Sodium
Use 1000 units/mL
or 5000 units/mL
|
Sodium Chloride
0.9%
|
Add 500 units/kg
to 50 mL syringe Sodium Chloride 0.9%.
1 mL/hr =
10 u/kg/hr
Dose range 10-40
units/kg/hour
(1 mL/hr =
10 units/kg/hr)
|
|
1unit/mL
|
Heparinised saline
Use 50 units/5 mL
|
Sodium Chloride
0.45%
|
Add 50 units (5 mL) to a 50
mL syringe
and
make up to 50 mL
|
|
5 units/mL
|
Heparin Sodium
Use 1000 units/mL
|
Sodium Chloride
0.9%
|
Add 2500 units (2.5 mL) to
500 mL bag, withdraw 50mL of final solution into 50mL syringe.
|
Route and method of
administration
IA and IV infusion:
Give as a continuous infusion at the prescribed rate via syringe pump.
Prime Line: Use Minimum Volume Extension tubing (Volume = 1 mL)
prime line with preloaded syringe
containing exact dose of Heparin.
Side effects
Bleeding, bruising, thrombocytopaenia (rare), urticarial.
Nursing
responsibilities
Observe infant for bleeding or
bruising.
Monitor IV site for extravasation.
Heparin is
incompatible with many medicines. Please flush line with Sodium
Chloride 0.9% before giving
other
medicines.
Compatibility information
IMPORTANT: Contact pharmacy for drugs not appearing in the table below. Uncommon drugs have simply been omitted and may be incompatible.
|
|
Compatible
|
Incompatible
|
|
|
Fluids
|
Glucose 5%, Glucose 10%, Glucose 25%, Sodium Chloride 0.45%, Sodium Chloride 0.9%
|
|
|
|
Drugs
|
Benzylpenicillin, Calcium Gluconate, Dopamine, Flucloxacillin, Fluconazole, Frusemide, Magnesium
Sulphate, Noradrenaline, Potassium Chloride, Ranitidine, Sodium
Bicarbonate
|
Amikacin, Amiodarone Diazepam,
Dobutamine, Gentamicin, Phenytoin, Vancomycin
|
|
|
Y-Site
|
Aciclovir, Adrenaline, Atropine, Caffeine Citrate5, Fentanyl, Hydrocortisone Sodium Succinate, Insulin (Neutral), Meropenem, Metronidazole,
Midazolam, Morphine Sulphate, Pancuronium, Phenobarbitone, Suxamethonium, Vecuronium, Zidovudine.
|
|
Reference:
- Neonatal Formulary: Drug use in pregnancy and the first year of life, 5th ed. 2007.
- RCH Paediatric Pharmacopoeia, 13th ed.
2002.
- Australian Injectables Handbook, SHPA,
5th ed. 2011.
- Lawrence Trissel, Handbook on Injectable Drugs, 17th ed.
2013.
- Thomas Young et al. Neofax, 22nd ed. 2009.
- RWH Neonatal Pharmacopoeia, 2nd ed. 2005.
- Cloherty J.P, Eichenwald E.C, Stark A.R. Manual of Neonatal Care,
6th ed. 2008.
- British National Formulary for Children,
2013 – 2014.
- Frank Shann, Drug Doses, RCH, 15th ed. 2010.