Parenteral Manual

Heparin sodium

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Alternate Name(s): 
HEPALEAN®
Classification: 
Anticoagulant
Original Date: 
August 2005
Revised Date: 
September 2011
Indications: 
  • Prevention or treatment of thromboembolic disorders
  • To prevent coagulation as blood passes through an extracorporeal circuit in dialysis procedures and during arterial and cardiac surgery
  • To maintain patency of IV catheter (hep lock)
  • Does not possess fibrinolytic activity, therefore cannot lyse established thrombi
Reconstitution and Stability: 
  • Stable at room temperature
  • Solutions are colourless to slightly yellow.  Minor colour variations do not affect potency
  • Heparin is available in many strengths;  please read label carefully:
    1. IV loading/bolus doses - 1,000 units/mL
    2. IV infusion - 100 units/mL
    3. SC use only - 10,000 units/mL
    4. Hep Lock - 100 units/mL
Compatibility: 

- Solutions Compatible: dextrose up to D10W, 0.9% NaCl, dextrose-saline combinations, RS, RL

- Additives/Above Cassette Compatible: clindamycin, dopamine, fentanyl, hydromorphone, KCl

-Y-site Compatible: amino acids/dextrose, hydrocortisone sodium succinate, calcium gluconate, digoxin, diphenhydramine, epinephrine, fluconazole, furosemide, lidocaine, morphine, norepinephrine, SMOF lipid 20%

Incompatible: alteplase, amikacin, ciprofloxacin, codeine, diazepam, erythromycin, fat emulsion (Intralipid 20%), gentamicin, phenytoin, and tobramycin - Infusion sets containing heparin should be irrigated with normal saline before these drugs are added.

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC

YES, deep SC (above iliac or abdominal fat layer)

Usual dilution: 10,000 units/mL
IM NO
IV Direct YES
Usual dilution: 1,000 units/mL
Infusion time: 5 minutes
IV Intermittent Infusion YES
Usual dilution: 40-1,000 units/mL
Infusion time: 10-15 minutes
IV Continuous Infusion YES
Usual dilution: 100 units/mL

Click here to access SDC Drug Infusion Sheet

Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatric: 
- Anticoagulant:

  • IV Infusion:       
    - Loading dose: 75 units/kg/dose IV over 10 minutes
    - Initial Maintenance:  <1 year: 28 units/kg/hour
                                           >1 year: 20 units/kg/hour
  • Adjust dose to maintain aPTT of 60-85 seconds

Adult:
- Thromboembolism prophylaxis:  5,000 units SC Q 8-12 hours

- Anticoagulant:

  • IV Intermittent: 10,000 units initially, then 50-70 units/kg Q 4-6 hours
  • IV Infusion:
    - Loading dose: 80 units/kg
    - Initial Maintenance: 18 units/kg/hour

- Individualize the maintenance dose based on monitoring of aPTT

Potential hazards of parenteral administration: 
  • Overdosage - hemorrhage; may require D/C heparin infusion (antidote:  protamine)
  • Hypersensitivity reactions: fever, urticaria, asthma, rhinitis, arthralgia, anaphylaxis
  • Heparin-induced thrombocytopenia; monitor platelets
  • Nausea, vomiting, elevated liver enzymes
Notes: 
  • Before initiation of treatment -review patient's total drug regimen to prevent concomitant use of low molecular weight heparin and unfractionated heparin
  • Obtain baseline CBC, PT, and aPTT before starting treatment 
  • Blood for aPTT should NOT be drawn on extremity where heparin drip is infusing; if indicated, a heparin-free IV could be started for subsequent blood sampling                         
  • Avoid IM route due to erratic absorption, pain and hematoma formation at the site of injection
  • For immediate anticoagulation, an intravenous bolus followed by a continuous IV infusion is given since there is a delay in absorption/onset via the SC route
  • Avoid arterial punctures and antiplatelet agents (ASA)
  • Heparin and warfarin are sometimes given in combination until warfarin therapy is stabilized (i.e. INR is therapeutic)

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