###### Whiteriver Service Unit Allergies 

**Heparin Standing Orders**

\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\--

+-----+----------------------+-------+---------+---------------------+---+
| *   | **Baseline**         | ■ P-7 | ■ CBC   | ■ aPTT & PT / INR   |   |
| *[L |                      | *(K   | *       |                     |   |
| abs | ***(get results      | ^+^)* | (plts)* |                     |   |
| ]{. | before starting      |       |         |                     |   |
| und | heparin)***          |       |         |                     |   |
| erl |                      |       |         |                     |   |
| ine |                      |       |         |                     |   |
| }** |                      |       |         |                     |   |
+-----+----------------------+-------+---------+---------------------+---+
|     | **Daily Follow-Up    | ##    | ##      | ■ aPTT / PT / INR   |   |
|     | Labs**               | ##### | ######  | ***(@               |   |
|     |                      |  ■ P- | ■ CBC * | therapeutic*)**     |   |
|     |                      | 7 *(K | (plts)* |                     |   |
|     |                      | ^+^)* |         |                     |   |
+-----+----------------------+-------+---------+---------------------+---+

+----------+---+---+----------+-----------+-----------+-----------+----------+---+
| **[Bolu  |   | I |          |           |           |           |          |   |
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+----------+---+---+----------+-----------+-----------+-----------+----------+---+
| #######  |   |   |          |           |           |           |          |   |
| ## Initi |   |   |          |           |           |           |          |   |
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| ion rate |   |   |          |           |           |           |          |   |
+----------+---+---+----------+-----------+-----------+-----------+----------+---+
| ##       | 1 |   |          |           |           |           |          |   |
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+----------+---+---+----------+-----------+-----------+-----------+----------+---+
| P        |   |   |          |           |           |           |          |   |
| re-mixed |   |   |          |           |           |           |          |   |
| Heparin  |   |   |          |           |           |           |          |   |
| drip is  |   |   |          |           |           |           |          |   |
| 20,000   |   |   |          |           |           |           |          |   |
| Units in |   |   |          |           |           |           |          |   |
| 500 mLs  |   |   |          |           |           |           |          |   |
| 5%       |   |   |          |           |           |           |          |   |
| Dextrose |   |   |          |           |           |           |          |   |
| (Conc =  |   |   |          |           |           |           |          |   |
| 40       |   |   |          |           |           |           |          |   |
| un       |   |   |          |           |           |           |          |   |
| its/mL). |   |   |          |           |           |           |          |   |
| Please   |   |   |          |           |           |           |          |   |
| refer to |   |   |          |           |           |           |          |   |
| drip     |   |   |          |           |           |           |          |   |
| rates on |   |   |          |           |           |           |          |   |
| reverse  |   |   |          |           |           |           |          |   |
| side.    |   |   |          |           |           |           |          |   |
|          |   |   |          |           |           |           |          |   |
| Drip     |   |   |          |           |           |           |          |   |
| Rate =   |   |   |          |           |           |           |          |   |
| \_\_\    |   |   |          |           |           |           |          |   |
| _\_\_\_\ |   |   |          |           |           |           |          |   |
| _\_\_\_\ |   |   |          |           |           |           |          |   |
| _\_mL/hr |   |   |          |           |           |           |          |   |
+----------+---+---+----------+-----------+-----------+-----------+----------+---+
| **[Die   |   |   | Low      |           |           |           |          |   |
| t]{.unde |   |   | Vitamin  |           |           |           |          |   |
| rline}** |   |   | K if     |           |           |           |          |   |
|          |   |   | patient  |           |           |           |          |   |
|          |   |   | is on    |           |           |           |          |   |
|          |   |   | warfarin |           |           |           |          |   |
|          |   |   | therapy  |           |           |           |          |   |
+----------+---+---+----------+-----------+-----------+-----------+----------+---+
| **       |   |   | Begin @  |           |           |           |          |   |
| [Warfari |   |   | 1700 the |           |           |           |          |   |
| n]{.unde |   |   | same day |           |           |           |          |   |
| rline}** |   |   | as       |           |           |           |          |   |
|          |   |   | heparin  |           |           |           |          |   |
|          |   |   | drip or  |           |           |           |          |   |
|          |   |   | 30 min   |           |           |           |          |   |
|          |   |   | post     |           |           |           |          |   |
|          |   |   | drip     |           |           |           |          |   |
|          |   |   | in       |           |           |           |          |   |
|          |   |   | itiation |           |           |           |          |   |
|          |   |   | if drip  |           |           |           |          |   |
|          |   |   | starts   |           |           |           |          |   |
|          |   |   | after    |           |           |           |          |   |
|          |   |   | 1700     |           |           |           |          |   |
+----------+---+---+----------+-----------+-----------+-----------+----------+---+
|          |   |   | Dose = 5 |           |           |           |          |   |
|          |   |   | mg/day,  |           |           |           |          |   |
|          |   |   | unless   |           |           |           |          |   |
|          |   |   | history, |           |           |           |          |   |
|          |   |   | risk     |           |           |           |          |   |
|          |   |   | factors, |           |           |           |          |   |
|          |   |   | or age   |           |           |           |          |   |
|          |   |   | (\>65    |           |           |           |          |   |
|          |   |   | yrs)     |           |           |           |          |   |
|          |   |   | su       |           |           |           |          |   |
|          |   |   | ggest(s) |           |           |           |          |   |
|          |   |   | o        |           |           |           |          |   |
|          |   |   | therwise |           |           |           |          |   |
+----------+---+---+----------+-----------+-----------+-----------+----------+---+
|          |   |   | For      |           |           |           |          |   |
|          |   |   | patients |           |           |           |          |   |
|          |   |   | pr       |           |           |           |          |   |
|          |   |   | eviously |           |           |           |          |   |
|          |   |   | on       |           |           |           |          |   |
|          |   |   | w        |           |           |           |          |   |
|          |   |   | arfarin, |           |           |           |          |   |
|          |   |   | use most |           |           |           |          |   |
|          |   |   | recent   |           |           |           |          |   |
|          |   |   | the      |           |           |           |          |   |
|          |   |   | rapeutic |           |           |           |          |   |
|          |   |   | dose     |           |           |           |          |   |
+----------+---+---+----------+-----------+-----------+-----------+----------+---+

**[Infusion Adjustments/Standing Orders]{.underline}** Based on aPTT
^\*\ \*^ drawn ***at least 6 hours*** after the ***start*** of heparin

drip and after 6 hours for ***[ANY AND ALL]{.underline}*** drip
adjustments. (Want aPTT 60 - 89 within 24 hrs)

+-------+---------------+---------------------+-----------------------+
| *     | **Drip Rate   | **Other Action**    | #                     |
| *aPTT | Change**      |                     |                       |
| (s    |               |                     |                       |
| ec)** |               |                     |                       |
+-------+---------------+---------------------+-----------------------+
| \< 40 | rate 4        | Rebolus at 80       | > ^\*^ If the heparin |
|       | Units/kg/hr   | Units/kg            | > drip is held, aPTT  |
|       |               |                     | > should be drawn at  |
|       |               |                     | > least 6 hours after |
|       |               |                     | > ***[resta           |
|       |               |                     | rting]{.underline}*** |
|       |               |                     | > the infusion        |
|       |               |                     | >                     |
|       |               |                     | > ^\*\*^ aPTTs must   |
|       |               |                     | > be drawn from the   |
|       |               |                     | > arm                 |
|       |               |                     | > ***[opp             |
|       |               |                     | osite]{.underline}*** |
|       |               |                     | > of that with the    |
|       |               |                     | > heparin drip        |
|       |               |                     | >                     |
|       |               |                     | > Standard IV care    |
|       |               |                     | > required            |
|       |               |                     |                       |
|       |               |                     | Do not disconnect     |
|       |               |                     | drip unless           |
|       |               |                     | specifically ordered  |
|       |               |                     | by doctor             |
+-------+---------------+---------------------+-----------------------+
| 40-49 | rate 4        | Rebolus at 40       |                       |
|       | Units/kg/hr   | Units/kg            |                       |
+-------+---------------+---------------------+-----------------------+
| 50-59 | rate 2        | None                |                       |
|       | Units/kg/hr   |                     |                       |
+-------+---------------+---------------------+-----------------------+
| 60-89 | **The         | Repeat aPTT in 6    |                       |
|       | rapeutic\--No | hrs to confirm      |                       |
|       | change**      |                     |                       |
+-------+---------------+---------------------+-----------------------+
| 90-99 | rate 1        | Draw aPTT in 6 hrs  |                       |
|       | Units/kg/hr   |                     |                       |
+-------+---------------+---------------------+-----------------------+
| 10    | rate 2        | Hold drip for 30    |                       |
| 0-115 | Units/kg/hr   | min^\*^             |                       |
+-------+---------------+---------------------+-----------------------+
| [     | rate 3        | > Hold drip for 1   |                       |
| \>]{. | Units/kg/hr   | > hr;^\*^ Call MD   |                       |
| under |               | > if pt has s/sxs   |                       |
| line} |               | > of bleeding, or   |                       |
| 116   |               | > if 3 consecutive  |                       |
|       |               | > aPTTs \> 116      |                       |
+-------+---------------+---------------------+-----------------------+

**[Discharge Criteria]{.underline}** Ideally, for acute DVT & PE,
heparin (aPTT) must be within therapeutic range for 5 consecutive days,
***and*** the patient's PT/INR therapeutic for 2 consecutive days prior
to stopping heparin & patient discharge

**Addressograph Physician Signature
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Date: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Time:
\_\_\_\_\_\_\_\_\_\_\_\_**

8/9/04 WRSU 45R

**Heparin Dosing Based on Ideal Body Weight [at Admission]{.underline}
(do not change drip rates based on changing weight)**

Concentration of Pre-Mixed Heparin 40 units/ml

+-----+-----+---------+------+--------+---------+---------+---------+
| #   | **I |         | **A  |        |         |         |         |
| IBW | nit |         | djus |        |         |         |         |
|     | ial |         | tmen |        |         |         |         |
|     | Do  |         | ts** |        |         |         |         |
|     | sin |         |      |        |         |         |         |
|     | g** |         | \*80 |        |         |         |         |
|     |     |         | Unit |        |         |         |         |
|     |     |         | s/kg |        |         |         |         |
|     |     |         | rebo |        |         |         |         |
|     |     |         | lus: |        |         |         |         |
|     |     |         | See  |        |         |         |         |
|     |     |         | ini  |        |         |         |         |
|     |     |         | tial |        |         |         |         |
|     |     |         | b    |        |         |         |         |
|     |     |         | olus |        |         |         |         |
|     |     |         | dose |        |         |         |         |
+-----+-----+---------+------+--------+---------+---------+---------+
| **W | ##  | **Inf   | ###  | **Infu | **Inf   | **Inf   | **Inf   |
| t** | ### | usion** | ## B | sion** | usion** | usion** | usion** |
|     |  Bo |         | olus |        |         |         |         |
| **  | lus | **18    |      | # 1    | **2     | **3     | **4     |
| (kg |     | U/      | **40 |  Units | Units/  | Units/  | Units/  |
| )** | #   | kg/hr** | Un   | /kg/hr | kg/hr** | kg/hr** | kg/hr** |
|     |  80 |         | its/ |        |         |         |         |
|     |  Un | ***(cc  | kg** | *      | ***(cc  | ***(cc  | ***(cc  |
|     | its | /hr)*** |      | **(cc/ | /hr)*** | /hr)*** | /hr)*** |
|     | /kg |         |      | hr)*** |         |         |         |
+-----+-----+---------+------+--------+---------+---------+---------+
| **3 | 2   | 630     | 1400 | 35     | 70      | 105     | 140     |
| 4-3 | 800 | *(15.8  |      | *(0.9  | *(1.8   | *(2.6   | *(3.5   |
| 6** |     | cc/hr)* |      | c      | cc/hr)* | cc/hr)* | cc/hr)* |
|     |     |         |      | c/hr)* |         |         |         |
+-----+-----+---------+------+--------+---------+---------+---------+
| **3 | 3   | 684     | 1520 | 38 *(1 | 76      | 114     | 152     |
| 7-3 | 040 | *(17.1  |      | c      | *(1.9   | *(2.9   | *(3.8   |
| 9** |     | cc/hr)* |      | c/hr)* | cc/hr)* | cc/hr)* | cc/hr)* |
+-----+-----+---------+------+--------+---------+---------+---------+
| **4 | 3   | 738     | 1640 | 41 *(1 | 82      | 123     | 164     |
| 0-4 | 280 | *(18.5  |      | c      | *(2.1   | *(3.1   | *(4.1   |
| 2** |     | cc/hr)* |      | c/hr)* | cc/hr)* | cc/hr)* | cc/hr)* |
+-----+-----+---------+------+--------+---------+---------+---------+
| **4 | 3   | 792     | 1760 | 44     | 88      | 132     | 176     |
| 3-4 | 520 | *(19.8  |      | *(1.1  | *(2.2   | *(3.3   | *(4.4   |
| 5** |     | cc/hr)* |      | c      | cc/hr)* | cc/hr)* | cc/hr)* |
|     |     |         |      | c/hr)* |         |         |         |
+-----+-----+---------+------+--------+---------+---------+---------+
| **4 | 3   | 846     | 1880 | 47     | 94      | 141     | 188     |
| 6-4 | 760 | *(21.2  |      | *(1.2  | *(2.4   | *(3.5   | *(4.7   |
| 8** |     | cc/hr)* |      | c      | cc/hr)* | cc/hr)* | cc/hr)* |
|     |     |         |      | c/hr)* |         |         |         |
+-----+-----+---------+------+--------+---------+---------+---------+
| **4 | 4   | 900     | 2000 | 50     | 100     | 150     | 200 *(5 |
| 9-5 | 000 | *(22.5  |      | *(1.3  | *(2.5   | *(3.8   | cc/hr)* |
| 1** |     | cc/hr)* |      | c      | cc/hr)* | cc/hr)* |         |
|     |     |         |      | c/hr)* |         |         |         |
+-----+-----+---------+------+--------+---------+---------+---------+
| **5 | 4   | 954     | 2120 | 53     | 106     | 159 *(4 | 212     |
| 2-5 | 240 | *(23.9  |      | *(1.3  | *(2.7   | cc/hr)* | *(5.3   |
| 4** |     | cc/hr)* |      | c      | cc/hr)* |         | cc/hr)* |
|     |     |         |      | c/hr)* |         |         |         |
+-----+-----+---------+------+--------+---------+---------+---------+
| **5 | 4   | 1008    | 2240 | 56     | 112     | 168     | 224     |
| 5-5 | 480 | *(25.2  |      | *(1.4  | *(2.8   | (4.2    | *(5.6   |
| 7** |     | cc/hr)* |      | c      | cc/hr)* | *       | cc/hr)* |
|     |     |         |      | c/hr)* |         | cc/hr)* |         |
+-----+-----+---------+------+--------+---------+---------+---------+
| **5 | 4   | 1062    | 2360 | 59     | 118 *(3 | 177     | 236     |
| 8-6 | 720 | *(26.6  |      | *(1.5c | cc/hr)* | *(4.4   | *(5.9   |
| 0** |     | cc/hr)* |      | c/hr)* |         | cc/hr)* | cc/hr)* |
+-----+-----+---------+------+--------+---------+---------+---------+
| **6 | 4   | 1116    | 2480 | 62     | 124     | 186     | 248     |
| 1-6 | 960 | *(27.9  |      | *(1.6  | *(3.1   | *(4.7   | *(6.2   |
| 3** |     | cc/hr)* |      | c      | cc/hr)* | cc/hr)* | cc/hr)* |
|     |     |         |      | c/hr)* |         |         |         |
+-----+-----+---------+------+--------+---------+---------+---------+
| **6 | 5   | 1170    | 2600 | 65     | 130     | 195     | 260     |
| 4-6 | 200 | *(29.3  |      | *(1.6  | *(3.3   | *(4.9   | *(6.5   |
| 6** |     | cc/hr)* |      | c      | cc/hr)* | cc/hr)* | cc/hr)* |
|     |     |         |      | c/hr)* |         |         |         |
+-----+-----+---------+------+--------+---------+---------+---------+
| **6 | 5   | 1224    | 2720 | 68     | 136     | 204     | 272     |
| 7-6 | 440 | *(30.6  |      | *(1.7  | *(3.4   | *(5.1   | *(6.8   |
| 9** |     | cc/hr)* |      | c      | cc/hr)* | cc/hr)* | cc/hr)* |
|     |     |         |      | c/hr)* |         |         |         |
+-----+-----+---------+------+--------+---------+---------+---------+
| **7 | 5   | 1278    | 2840 | 71     | 142     | 213     | 284     |
| 0-7 | 680 | *(32    |      | *(1.8  | *(3.6   | *(5.3   | *(7.1   |
| 2** |     | cc/hr)* |      | c      | cc/hr)* | cc/hr)* | cc/hr)* |
|     |     |         |      | c/hr)* |         |         |         |
+-----+-----+---------+------+--------+---------+---------+---------+
| **7 | 5   | 1332    | 2960 | 74     | 148     | 222     | 296     |
| 3-7 | 920 | *(33.3  |      | *(1.9  | *(3.7   | *(5.6   | *(7.4   |
| 5** |     | cc/hr)* |      | c      | cc/hr)* | cc/hr)* | cc/hr)* |
|     |     |         |      | c/hr)* |         |         |         |
+-----+-----+---------+------+--------+---------+---------+---------+
| **7 | 6   | 1386    | 3080 | 77     | 154     | 231     | 308     |
| 6-7 | 160 | *(34.7  |      | *(1.9  | *(3.9   | *(5.8   | *(7.7   |
| 8** |     | cc/hr)* |      | c      | cc/hr)* | cc/hr)* | cc/hr)* |
|     |     |         |      | c/hr)* |         |         |         |
+-----+-----+---------+------+--------+---------+---------+---------+
| **7 | 6   | 1440    | 3200 | 80 *(2 | 160 *(4 | 240 *(6 | 320 *(8 |
| 9-8 | 400 | *(36    |      | c      | cc/hr)* | cc/hr)* | cc/hr)* |
| 1** |     | cc/hr)* |      | c/hr)* |         |         |         |
+-----+-----+---------+------+--------+---------+---------+---------+
| **8 | 6   | 1494    | 3320 | 83     | 166     | 249     | 332     |
| 2-8 | 640 | *(37.4  |      | *(2.1  | *(4.2   | *(6.2   | *(8.3   |
| 4** |     | cc/hr)* |      | c      | cc/hr)* | cc/hr)* | cc/hr)* |
|     |     |         |      | c/hr)* |         |         |         |
+-----+-----+---------+------+--------+---------+---------+---------+
| **8 | 6   | 1548    | 3440 | 86     | 172     | 258     | 344     |
| 5-8 | 880 | *(38.7  |      | *(2.2  | *(4.3   | *(6.5   | *(8.6   |
| 7** |     | cc/hr)* |      | c      | cc/hr)* | cc/hr)* | cc/hr)* |
|     |     |         |      | c/hr)* |         |         |         |
+-----+-----+---------+------+--------+---------+---------+---------+
| **8 | 7   | 1602    | 3560 | 89     | 178     | 267     | 356     |
| 8-9 | 120 | *(40    |      | *(2.2  | *(4.5   | *(6.7   | *(8.9   |
| 0** |     | cc/hr)* |      | c      | cc/hr)* | cc/hr)* | cc/hr)* |
|     |     |         |      | c/hr)* |         |         |         |
+-----+-----+---------+------+--------+---------+---------+---------+
| **9 | 7   | 1656    | 3680 | 92 *(  | 184     | 276     | 368     |
| 1-9 | 360 | *(41.4  |      | 2.3    | *(4.6   | *(6.9   | *(9.2   |
| 3** |     | cc/hr)* |      | c      | cc/hr)* | cc/hr)* | cc/hr)* |
|     |     |         |      | c/hr)* |         |         |         |
+-----+-----+---------+------+--------+---------+---------+---------+
| **9 | 7   | 1710    | 3800 | 95     | 190     | 285     | 380     |
| 4-9 | 600 | *(42.8  |      | *(2.4  | *(4.8   | *(7.1   | *(9.5   |
| 6** |     | cc/hr)* |      | c      | cc/hr)* | cc/hr)* | cc/hr)* |
|     |     |         |      | c/hr)* |         |         |         |
+-----+-----+---------+------+--------+---------+---------+---------+

**Ideal Body Weight based on height---NOTE: If patient's Actual Body Wt
is less than Ideal Body Wt, use Actual**

<table>
<colgroup>
<col style="width: 5%" />
<col style="width: 5%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 5%" />
<col style="width: 5%" />
<col style="width: 7%" />
<col style="width: 6%" />
<col style="width: 5%" />
<col style="width: 5%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 5%" />
<col style="width: 5%" />
<col style="width: 7%" />
<col style="width: 6%" />
</colgroup>
<tbody>
<tr class="odd">
<td>Height (ft, in)</td>
<td>Height (in)</td>
<td><p>IBW (kg)</p>
<p>Female</p></td>
<td><p>IBW (kg)</p>
<p>Male</p></td>
<td><p>Height</p>
<p>(ft, in)</p></td>
<td><p>Height</p>
<p>(in)</p></td>
<td><p>IBW (kg)</p>
<p>Female</p></td>
<td><p>IBW (kg)</p>
<p>Male</p></td>
<td>Height (ft, in)</td>
<td>Height (in)</td>
<td><p>IBW (kg)</p>
<p>Female</p></td>
<td><p>IBW (kg)</p>
<p>Male</p></td>
<td>Height (ft, in)</td>
<td>Height (in)</td>
<td><p>IBW (kg)</p>
<p>Female</p></td>
<td><p>IBW (kg)</p>
<p>Male</p></td>
</tr>
<tr class="even">
<td>4' 7"</td>
<td>55</td>
<td>35 (est)</td>
<td>40 (est)</td>
<td>5' 1"</td>
<td>61</td>
<td>47.8</td>
<td>52.3</td>
<td>5' 7"</td>
<td>67</td>
<td>61.6</td>
<td>66.1</td>
<td>6' 2"</td>
<td>74</td>
<td>77.7</td>
<td>82.2</td>
</tr>
<tr class="odd">
<td>4' 8"</td>
<td>56</td>
<td>37 (est)</td>
<td>42 (est)</td>
<td>5' 2"</td>
<td>62</td>
<td>50.1</td>
<td>54.6</td>
<td>5' 8"</td>
<td>68</td>
<td>63.9</td>
<td>68.4</td>
<td>6' 3"</td>
<td>75</td>
<td>80</td>
<td>84.5</td>
</tr>
<tr class="even">
<td>4' 9"</td>
<td>57</td>
<td>39 (est)</td>
<td>44 (est)</td>
<td>5' 3"</td>
<td>63</td>
<td>52.4</td>
<td>56.9</td>
<td>5' 9"</td>
<td>69</td>
<td>66.2</td>
<td>70.7</td>
<td>6' 4"</td>
<td>76</td>
<td>82.3</td>
<td>86.8</td>
</tr>
<tr class="odd">
<td>4' 10"</td>
<td>58</td>
<td>41 (est)</td>
<td>46 (est)</td>
<td>5' 4"</td>
<td>64</td>
<td>54.7</td>
<td>59.2</td>
<td>5' 10"</td>
<td>70</td>
<td>68.5</td>
<td>73</td>
<td>6' 5"</td>
<td>77</td>
<td>84.6</td>
<td>89.1</td>
</tr>
<tr class="even">
<td>4' 11"</td>
<td>59</td>
<td>43 (est)</td>
<td>48 (est)</td>
<td>5' 5"</td>
<td>65</td>
<td>57</td>
<td>61.5</td>
<td>5' 11"</td>
<td>71</td>
<td>70.8</td>
<td>75.3</td>
<td>6' 6"</td>
<td>78</td>
<td>86.9</td>
<td>91.4</td>
</tr>
<tr class="odd">
<td>5 '</td>
<td>60</td>
<td>45.5</td>
<td>50</td>
<td>5' 6"</td>
<td>66</td>
<td>59.3</td>
<td>63.8</td>
<td>6'</td>
<td>72</td>
<td>73.1</td>
<td>77.6</td>
<td>6' 7"</td>
<td>79</td>
<td>89.2</td>
<td>93.7</td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>6' 1"</td>
<td>73</td>
<td>75.4</td>
<td>79.9</td>
<td>6' 8"</td>
<td>80</td>
<td>91.5</td>
<td>96</td>
</tr>
</tbody>
</table>

Pt Name:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Pt ID
Number:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Weight on which dosing was based:
\_\_\_\_\_\_\_\_\_\_\_ kg

+--------+------------+----------+-----------+-------------+----------+
| Bolus  | ####       | Drip     | ####      | ####        | D        |
|        | Date/time  | rate     | Drip rate |  Date/time  | ate/time |
| (      |            |          |           |             |          |
| units) |            | (u       | ####      | #           | #        |
|        |            | nits/hr) |  (mLs/hr) | ### Started | ### aPTT |
|        |            |          |           |             |  due^\*^ |
+--------+------------+----------+-----------+-------------+----------+
| aPTT   | Drip       | New Rate | New Rate  | Date/time   | D        |
|        | adjustment |          |           |             | ate/time |
| (sec)  | (un        | (u       | (mLs/hr)  | of Rate     |          |
|        | its/kg/hr) | nits/hr) |           | change      | #        |
|        |            |          |           |             | ### aPTT |
|        |            |          |           |             |  due^\*^ |
+--------+------------+----------+-----------+-------------+----------+
| aPTT   | Drip       | New Rate | New Rate  | Date/time   | D        |
|        | adjustment |          |           |             | ate/time |
| (sec)  | (un        | (u       | (mLs/hr)  | of Rate     |          |
|        | its/kg/hr) | nits/hr) |           | change      | #        |
|        |            |          |           |             | ### aPTT |
|        |            |          |           |             |  due^\*^ |
+--------+------------+----------+-----------+-------------+----------+
| aPTT   | Drip       | New Rate | New Rate  | Date/time   | D        |
|        | adjustment |          |           |             | ate/time |
| (sec)  | (un        | (u       | (mLs/hr)  | of Rate     |          |
|        | its/kg/hr) | nits/hr) |           | change      | #        |
|        |            |          |           |             | ### aPTT |
|        |            |          |           |             |  due^\*^ |
+--------+------------+----------+-----------+-------------+----------+
| aPTT   | Drip       | New Rate | New Rate  | Date/time   | D        |
|        | adjustment |          |           |             | ate/time |
| (sec)  | (un        | (u       | (mLs/hr)  | of Rate     |          |
|        | its/kg/hr) | nits/hr) |           | change      | #        |
|        |            |          |           |             | ### aPTT |
|        |            |          |           |             |  due^\*^ |
+--------+------------+----------+-----------+-------------+----------+
| aPTT   | Drip       | New Rate | New Rate  | Date/time   | D        |
|        | adjustment |          |           |             | ate/time |
| (sec)  | (un        | (u       | (mLs/hr)  | of Rate     |          |
|        | its/kg/hr) | nits/hr) |           | change      | #        |
|        |            |          |           |             | ### aPTT |
|        |            |          |           |             |  due^\*^ |
+--------+------------+----------+-----------+-------------+----------+
| aPTT   | Drip       | New Rate | New Rate  | Date/time   | D        |
|        | adjustment |          |           |             | ate/time |
| (sec)  | (un        | (u       | (mLs/hr)  | of Rate     |          |
|        | its/kg/hr) | nits/hr) |           | change      | #        |
|        |            |          |           |             | ### aPTT |
|        |            |          |           |             |  due^\*^ |
+--------+------------+----------+-----------+-------------+----------+
| aPTT   | Drip       | New Rate | New Rate  | Date/time   | D        |
|        | adjustment |          |           |             | ate/time |
| (sec)  | (un        | (u       | (mLs/hr)  | of Rate     |          |
|        | its/kg/hr) | nits/hr) |           | change      | #        |
|        |            |          |           |             | ### aPTT |
|        |            |          |           |             |  due^\*^ |
+--------+------------+----------+-----------+-------------+----------+
| aPTT   | Drip       | New Rate | New Rate  | Date/time   | D        |
|        | adjustment |          |           |             | ate/time |
| (sec)  | (un        | (u       | (mLs/hr)  | of Rate     |          |
|        | its/kg/hr) | nits/hr) |           | change      | #        |
|        |            |          |           |             | ### aPTT |
|        |            |          |           |             |  due^\*^ |
+--------+------------+----------+-----------+-------------+----------+
| aPTT   | Drip       | New Rate | New Rate  | Date/time   | D        |
|        | adjustment |          |           |             | ate/time |
| (sec)  | (un        | (u       | (mLs/hr)  | of Rate     |          |
|        | its/kg/hr) | nits/hr) |           | change      | #        |
|        |            |          |           |             | ### aPTT |
|        |            |          |           |             |  due^\*^ |
+--------+------------+----------+-----------+-------------+----------+
| aPTT   | Drip       | New Rate | New Rate  | Date/time   | D        |
|        | adjustment |          |           |             | ate/time |
| (sec)  | (un        | (u       | (mLs/hr)  | of Rate     |          |
|        | its/kg/hr) | nits/hr) |           | change      | #        |
|        |            |          |           |             | ### aPTT |
|        |            |          |           |             |  due^\*^ |
+--------+------------+----------+-----------+-------------+----------+
| aPTT   | Drip       | New Rate | New Rate  | Date/time   | D        |
|        | adjustment |          |           |             | ate/time |
| (sec)  | (un        | (u       | (mLs/hr)  | of Rate     |          |
|        | its/kg/hr) | nits/hr) |           | change      | #        |
|        |            |          |           |             | ### aPTT |
|        |            |          |           |             |  due^\*^ |
+--------+------------+----------+-----------+-------------+----------+
| aPTT   | Drip       | New Rate | New Rate  | Date/time   | D        |
|        | adjustment |          |           |             | ate/time |
| (sec)  | (un        | (u       | (mLs/hr)  | of Rate     |          |
|        | its/kg/hr) | nits/hr) |           | change      | #        |
|        |            |          |           |             | ### aPTT |
|        |            |          |           |             |  due^\*^ |
+--------+------------+----------+-----------+-------------+----------+
| aPTT   | Drip       | New Rate | New Rate  | Date/time   | D        |
|        | adjustment |          |           |             | ate/time |
| (sec)  | (un        | (u       | (mLs/hr)  | of Rate     |          |
|        | its/kg/hr) | nits/hr) |           | change      | #        |
|        |            |          |           |             | ### aPTT |
|        |            |          |           |             |  due^\*^ |
+--------+------------+----------+-----------+-------------+----------+

*^\*^Draw aPTT at least 6 hours after the drip is started or
changed/restarted.* **To determine mLs/hr drip rate: ( *x* units/hr) ÷
(40 units/mL) = *y* mLs/hr**

Nursing Flow Sheet\--Not part of patient's permanent record; please
return to pharmacy when heparin is discontinued.