Do you allow Heparin to be mixed in different base fluids?

[Dred Pirate]

Do any of your institutions have restrictions on what base fluids heparin can be mixed in? Ex - only the D5w vs NS?

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[Its Z]

We typically don't mix Heparin for infusion. And with the Joint Commission Elements of Performance and CMS medication management recommendations of "single" concentration in stock, we only stock 25,000 units/500mL in D5W which is commercially available. This however doesn't really affect having 2 different base solutions yet, our practice generally doesn't involve mixing Heparin.

Since Heparin is considered as one of the High Alert Medications (HAM), it does require 2 nurses to administer (hang, titrate etc).

So I wouldn't be opposed allowing using different base solutions, but only under special circumstances where patient's clinical status requires it.

 

[Dred Pirate]

We typically don't mix Heparin for infusion. And with the Joint Commission Elements of Performance and CMS medication management recommendations of "single" concentration in stock, we only stock 25,000 units/500mL in D5W which is commercially available. This however doesn't really affect having 2 different base solutions yet, our practice generally doesn't involve mixing Heparin.

Since Heparin is considered as one of the High Alert Medications (HAM), it does require 2 nurses to administer (hang, titrate etc).

So I wouldn't be opposed allowing using different base solutions, but only under special circumstances where patient's clinical status requires it.

In this case the patient was hyponatremic - so the MD wanted to change from D5W (which we have in a premix) to NS (which we would have to make) - which made sense, but some institutions locally do not allow it because they say since we are mixing it up and it is high alert - there is increased risk of an error. Just wondering what people's opinion is - worth the trade off?

 

[mustang sally]

In this case the patient was hyponatremic - so the MD wanted to change from D5W (which we have in a premix) to NS (which we would have to make) - which made sense, but some institutions locally do not allow it because they say since we are mixing it up and it is high alert - there is increased risk of an error. Just wondering what people's opinion is - worth the trade off?

I don't think we have any specific policy regarding mixing heparin in other solutions that I'm aware of. However, there are plenty of other high alert medications that we do have to mix so I don't see why it would matter. Also if we couldn't get the premixed heparin drip because of drug shortages, we would mix it anyway.

 

[Dred Pirate]

I don't think we have any specific policy regarding mixing heparin in other solutions that I'm aware of. However, there are plenty of other high alert medications that we do have to mix so I don't see why it would matter. Also if we couldn't get the premixed heparin drip because of drug shortages, we would mix it anyway.

I agree - I didn't think it was a big deal, but others had different opinions

 

[pharmasaur]

we have both Heparin in D5w and Heparin in 1/2 NS (I think from Braun). we do compound in other bases and concentrations.....ie, what if its for baby or child. but our pharmacists are supposed to double check all heparins and then the nurses double check on the floor. so 4 checks total!

 

[Dred Pirate]

we have both Heparin in D5w and Heparin in 1/2 NS (I think from Braun). we do compound in other bases and concentrations.....ie, what if its for baby or child. but our pharmacists are supposed to double check all heparins and then the nurses double check on the floor. so 4 checks total!

what concentration? If we could get that in 1/2 NS for cases like this (this patient was hyponatremic and I really didn't want to give him 1.5 L of free water and average that out with hypertonic saline. We have 40 units/ml

 

[pharmasaur]

still 25,000 units same as D5w

 

[DrWrong]

We carry the commercially available Heparin 25,000/500 mL of D5W. As Z said above, we will prepare Heparin 25,000/500 mL of NS if the patient's clinical status requires it (hyperglycemic)