Orders

1. PTT, PT, CBC now
2. CBC every 3 days
3. Give Heparin bolus IV:
4. Start heparin infusion IV: ml/hr
5. STAT PTT 6 hours after heparin is started
6. Adjust heparin according to scale below
7. PTT 6 hours AFTER ANY DOSE CHANGE and adjust per table below
8. When 2 consecutive 6 hour PTTs are therapeutic, then order the next PTT in A.M. daily (and readjust heparin per scale below)
9. Notify physician if PTT is greater than 150
10. Record information on anticoagulation flowsheet

Range	PTT	Hold Heparin	Give Heparin Bolus (units)	Inc/Dec	Heparin Rate (ml/hr)
Low	<30	No	(50xW)	Increase	(4xF)
Low	30-40	No	(25xW)	Increase	(2xF)
Low	41-49	No	None	Increase	(1xF)
-----
OK	50-80	No	None	No change
-----
High	81-90	No	None	Decrease	(1xF)
High	91-100	1 Hr	None	Decrease	(2xF)
High	101-120	2 Hr	None	Decrease	(4xF)
High	121-150	3 Hr	None	Decrease	(5xF)
High	>150	Call Physician

Note: All bolus doses are rounded to the nearest 500 units and the maximum bolus dose is 7500 units.

Date Signature _____________________________