How to Give a Heparin Bolus Module

Heparin syringe

Heparin is also called "blood thinners" and is used for different medical conditions such as clot prevention for Deep Vein Thrombosis (DVT) to stop the growth of clots that have already formed in the blood vessels. It is also used in small amounts to prevent formation of blood clots in catheters or heparin locks, also called "heplocks," that are left in veins over a period of time. Heparin also can be given deeply under the skin and as a diluted solution to be injected into intravenous (IV) catheters.

Things You'll Need

• Syringe and needle
• Correct heparin dose
• Doctor's order
• Gloves
• Hand sanitizer or soap and water
• Alcohol swab
• 2-by-2-inch gauze pad
• Portable sharp container

Instructions

1. 

   Prefilled syringe

   Determine the dosing weight, loading dose and infusion rate of the medication. Normally, the hospital pharmacy already will have a prefilled syringe to be given to the patient.

2. 

   Always check for doctor's order, accuracy and completeness.

   Obtain, review and check for accuracy and completeness of the doctor's order. Check the medication with the order. Review the patient's chart or medication record for previous dose and site. Check for the appropriate lab values related to heparin therapy protocol if this is the patient's first dose.

3. 

   Hand washing is a universal precaution.

   Wash your hands and prepare the medication. Do an independent double check of the medication if heparin is considered a "high-alert drug" in your hospital. Otherwise, having a second or third licensed individual check the medication will not hurt and will increase medication administration safety.

4. 

   Name tags or arm bands are patient identifiers.

   Complete a patient identification process. Ask for the patient's name. If the patient is unresponsive, check the patient's arm band for the correct name and medical identification number against the doctor's order. When the patient's identity is confirmed, explain the procedure to the patient. Always remember that just because a patient cannot speak, it does not mean that he cannot hear.

5. 

   Don't aspirate the needle.

   Wash your hands and don gloves. Pick a vein where you want to give the Heparin bolus IV. It is best to choose a large vein, such as the vein located in the antecubital fossa of the arm. Wipe the site with an alcohol swab and ask the patient to relax. Hold down the vein, then insert the needle at a 45 degree angle and slowly inject the medication without aspirating. Advise the patient not to move, as this can cause bruising or bleeding.

6. 

   2-by-2-inch gauze pads

   Press the 2-by-2-inch gauze pad to the injection site, and hold for up to two minutes if the patient is bleeding. Never use an alcohol swab to press on the site, since alcohol promotes more bleeding. Don't rub the site.

7. Discard the syringe in your portable or wall-mounted sharps container. Remove gloves and wash your hands.

8. Assess and document the patient's reaction to the injection, and make note of any bleeding or adverse effects. Report to the physician for any abnormal findings or side effects.

Tips & Warnings

• Heparin is a medication that is traditionally dosed with an IV bolus of 5,000 to 10,000 units of heparin, followed by an infusion of 1,000 units per hour depending on each hospital policy protocol on heparin administration.

• Monitor for bleeding, such as bleeding gums, bruises, black tarry stools, brown vomit and nose bleed. Check related labs per protocol.

Resources

• Amazon: "Low Molecular Weight Heparin Therapy"; Sarret/Kher/Toulemonde, editors; 1999