Disclaimer to the Online Edition
This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.
heparin sodium
Indication
- Thrombosis prophylaxis/Infection Prevention for umbilical arterial lines (UAL), peripheral arterial lines (PAL), peripherally inserted central catheters (PICC) and central venous lines (CVL)
- Thrombosis treatment
Dosage Guidelines
- Standardized heparin dosing for PICC/CVL: (1 unit/mL syringe)
Present Weight | Rate (mL/hr) | Dose Range (units/kg/hr) |
|---|---|---|
Less than 750 g | 0.3 | ~ 0.4 – 0.67 |
750 – 1249 g | 0.5 | 0.4 – 0.67 |
1250 – 1750 g | 0.7 | 0.4 – 0.56 |
Greater than 1750 g | 1 | Less than 0.55 |
- Standardized heparin dosing for UAL/PAL (1 unit/mL syringe) is 0.5 mL/hr for all weights
Standard solution for dilution is 0.45% NaCl. May use dextrose solutions in the cases of hypernatremia or hypoglycemia. ELGA patients should use heparin 1 unit/mL in 0.077 mmol/mL sodium acetate
- Thrombosis treatment (100 units/mL syringe): Initial loading dose 75 units/kg over 10 minutes and then initial continuous maintenance infusion at 28 units/kg/hr. Adjust dose based on hematology recommendations
Administration
- IV continuous infusion
Adverse Effects
- Rare at concentrations used for thrombosis prophylaxis/infection prevention
- Thrombocytopenia, bleeding: monitor for nosebleeds, hematuria, melena
Comments
- Frequent flushing of line may heparinize infant. If line used for medications, recommend monitoring INR
- May run heparin in a UAL/PAL and a PICC/CVL concurrently at the recommended dosages
- Heparin antidote: Protamine – administer slow IV direct over 10 minutes
Time since last heparin dose | Dose to neutralize 100 units of heparin |
|---|---|
Less than 30 minutes | 1 mg |
30 – 60 minutes | 0.5 – 0.75 mg |
61 – 120 minutes | 0.375 – 0.5 mg |
Greater than 120 minutes | 0.25 – 0.375 mg |
Supplied As
- Wardstock syringes of heparin 1 unit/mL 0.45% NaCL (50 mL)
- Wardstock syringes of heparin 1 unit/mL in 3.85 mmol sodium acetate (50 mL) for ELGA patients
- For thrombosis treatment, IV syringe prepared by Pharmacy 100 units/mL syringe (50 mL)
References
LexiComp Sick Kids, LexiComp Pediatric and Neonatal, Neofax