From the Guidelines
Heparin infusion via a Peripherally Inserted Central Catheter (PICC) line should be administered using a weight-based dosing algorithm, starting with an 80 U/kg bolus followed by 18 U/kg per hour, as recommended by the most recent guidelines 1. When administering heparin infusion through a PICC line, it is essential to follow a validated dose adjustment nomogram using the activated partial thromboplastin time (aPTT) to ensure optimal anticoagulation. The goal is to achieve an aPTT ratio of 1.5 to 2.5, which corresponds to heparin levels of 0.3 to 0.7 IU/mL measured by an antifactor Xa assay 1. Some key considerations for heparin infusion via PICC line include:
- Using a weight-based dosing algorithm to minimize the risk of over- or under-anticoagulation
- Monitoring aPTT levels regularly to adjust the infusion rate as needed
- Maintaining aseptic technique and proper hand hygiene during all manipulations of the PICC line
- Labeling the PICC line clearly and documenting the flush protocol to prevent errors
- Flushing the catheter with normal saline before and after insertion, followed by the heparin solution to establish and maintain patency It is crucial to prioritize the patient's safety and minimize the risk of complications, such as catheter-associated thrombosis, by adhering to evidence-based guidelines and protocols for heparin infusion via PICC line 1.
From the Research
Heparin Administration via PICC Line
The procedure for administering Heparin (heparin sodium) infusion via a Peripherally Inserted Central Catheter (PICC) line involves several key steps:
- Initiation of therapy: Heparin is typically administered as an intravenous bolus followed by a continuous infusion 2, 3.
- Dosing: The initial dose of heparin can be calculated using a weight-based nomogram, with a starting dose of 80 units/kg body weight bolus and 18 units/kg per hour infusion 2.
- Monitoring: Activated partial thromboplastin time (APTT) values are monitored every 6 hours to adjust the heparin dose and maintain therapeutic anticoagulation 2, 3, 4.
- Adjustment of infusion rate: The heparin infusion rate is adjusted based on the APTT values to maintain a therapeutic range (APTT, 1.5 to 2.3 times the control) 2, 3.
Considerations for Special Populations
- Obese patients: Standard weight-based heparin dosing protocols may result in significant delays in achieving therapeutic anticoagulation in obese patients, and alternative dosing strategies may be necessary 5.
- Morbidly obese patients: A dosing weight can be calculated using formulas such as dosing weight = ideal body weight (IBW) + 0.3(actual body weight [ABW] - IBW) or dosing weight = IBW + 0.4(ABW - IBW) to determine initial heparin dosing 5.
Monitoring and Safety
- Antifactor Xa levels: Antifactor Xa heparin assay (anti-Xa) can be used as an alternative to APTT for monitoring unfractionated heparin, with potential benefits including reduced discordance between paired values and improved maintenance of therapeutic range 4.
- Bleeding complications: Patients with discordant values presenting with high APTT to normal anti-Xa values may have an increased risk of bleeding complications, and close monitoring is necessary to minimize this risk 4.