Neonatal Drug Therapy Manual

Heparin

Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Hepalean
Classification: 
Anticoagulant
Original Date: 
June 1996
Revised Date: 
November 2018
Indications: 
  • Maintaining patency of arterial catheters, PICC lines and umbilical venous catheters
  • Treatment of thromboembolic disorders
Administration: 
  • IV continuous infusion
    • Maintaining patency of arterial catheters, PICC lines and umbilical venous catheters
      • Use 0.5 unit/mL concentration
    • Treatment of thromboembolic disorders
      • Use 100 units/mL concentration
Dosage: 
  • Maintaining patency of arterial catheters, PICC lines and umbilical venous catheters
    • 0.5 unit/mL, 0.5 - 2 mL/hr
  • Treatment of thromboembolic disorders
    • Loading dose *:
      • 75 units/kg/hr IV over 10 minutes
    • Initial maintenance dose:
      •  28  units/kg/hr
      • Adjust dose to maintain aPTT of 60 - 85 seconds (assuming this reflects an  Anti-Factor Xa of 0.35 - 0.7 units/mL)

* Evaluate risk of bleeding and if high, do not give the bolus

Side Effects: 
  • CNS: fever
  • GI: nausea and vomiting
  • Hematologic: thrombocytopenia (HIT: heparin induced thrombocytopenia)
  • Hepatic: liver enzymes elevated

For use to maintain arterial lines, systemic side effects are unlikely to occur

Parameters to Monitor: 
  • Platelet counts
  • Signs of bleeding
  • Hemoglobin, hematocrit
  • aPTT (Anti-Factor Xa)
  • Liver enzymes
Reconstitution and Stability: 

TOH:

To make Heparin 0.5 unit/mL solution:

  • Use Heparin 1000 units/mL:
  • Take 1 mL (1000 units) add to 9 mL of SWFI.  Final concentration: 100 units/mL
  • Take 0.5 mL (50 units) of the above dilution, add to 100 mL of IV fluids.
  • Approximate final concentration : 0.5 unit/mL
Compatibility: 

Compatibility:

- Solutions Compatible: Dextrose solutions, 0.45% NaCl, 0.9% NaCl, dextrose-saline combinations

- May be mixed by pharmacy in Na Acetate 7.7 mmol/100 mL (sodium equivalent of 0.45% NaCl)

- Y-site Compatible: acyclovir, atropine, ampicillin, calcium gluconate, cefazolin, cloxacillin, dopamine, epinephrine, fentanyl, fluconazole, furosemide, KCl, ketamine*, meropenem, midazolam, morphine, ranitidine, sodium bicarbonate, SMOF, TPN

 

- Incompatible: dobutamine, gentamicin*, tobramycin*, vancomycin*

 

* Heparin at low concentrations of 0.5 to 1 unit/mL that are used to maintain IV line patency is considered  compatible with Gentamicin, Ketamine (10 mg/mL), Tobramycin and Vancomycin at the Y-site

References: 

- Taketomo CK, Hodding JH, Kraus DM. Pediatric Dosage Handbook 20th Edition. Hudson: Lexi-Comp Inc; 2013

- Trissel LA. Handbook on Injectable Drugs. 17th Editions. Bethesda: American Society of Health-System Pharmacists; 2010

- Zenk KE, Sills JH, Koeppel RM.  Neonatal Medications & Nutrition A Comprehensive Guide 3rd Edition. Santa Rosa, CA: NICU Ink; 2003

-King Guide to Parenteral Admixtures Internet Edition. Retrieved from http://kingguide.com

 

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