1. No category

First Name:
Surname:
Sample only - not
for clinical use
Weight:
Hospital No:
HEPARIN INTRAVENOUS PRESCRIPTION (PAEDIATRICS)
kg
Consultant:
CHECK ALLERGY STATUS ON MAIN DRUG CHART
Route
Prescriber’s Signature
(use addressograph if available)
Print name & Contact no.
Maintenance of IV infusion of heparin : Prescriber to circle ONE correct strength 
APTT RECORD
Date
Pharm check
Administration
Date
Time
Guidance
less than 5kg
5,000 units in 50mL of sodium chloride 0.9% (100 units / mL)
5kg to 19kg
10,000 units in 40mL of sodium chloride 0.9% (250 units / mL)
20kg to 39kg
20,000 units in 40mL of sodium chloride 0.9% (500 units / mL)
40,000 units in 40mL of sodium chloride 0.9% (1000 units / mL) 40kg and above
CONTINUOUS INFUSION PRESCRIPTION
INFUSION SOLUTION
APTT
Hospital:
Sign 1 (& print name)
Sign 2 (& print name)
IV
units over 10 minutes
Date &
Time
DOB:
Ward
Loading dose of heparin (do not load if tinzaparin stopped within 24hours or enoxaparin stopped within 12hours)
Dose
NHS No:
Dose
change?
Prescriber to sign correct strength 
100 units/mL
250 units/mL
500 units/mL
1000 units/mL
ADDITIONAL IV BOLUS DOSE PRESCRIPTION
Administration
Date & Time
Infusion rate
Prescriber’s Signature
(please circle)
Y
N
units/kg/hour
units/hour
mL/hour
Y
N
units/kg/hour
units/hour
mL/hour
Y
N
units/kg/hour
units/hour
mL/hour
Y
N
units/kg/hour
units/hour
mL/hour
Y
N
units/kg/hour
units/hour
mL/hour
Y
N
units/kg/hour
units/hour
mL/hour
Y
N
units/kg/hour
units/hour
mL/hour
Y
N
units/kg/hour
units/hour
mL/hour
Y
N
units/kg/hour
units/hour
mL/hour
Y
N
units/kg/hour
units/hour
mL/hour
Y
N
units/kg/hour
units/hour
mL/hour
Y
N
units/kg/hour
units/hour
mL/hour
(check rate and
infusion pump setting)
Sig 1
Sig 2
Dose
Prescriber’s Signature
Administration
Sig 1
Sig 2
SEE OVERLEAF FOR SYRINGE PREPARATION
PRESCRIPTION TO BE USED IN CON JUNCTION WITH THE PROTOCOL FOR THE USE OF ANTI-THROMBOTIC TREATMENT IN CHILDREN
Syringe preparation (change syringe every 24 hours)
Date & Time
Heparin 1000 units / mL
Batch No.
Sodium Chloride 0.9%
Volume
Batch No.
Prepared by:
Volume
Sign 1 (& print name)
Sign 2 (& print name)
Sample only - not
for clinical use
Protocol for Anticoagulation with Unfractionated Heparin in Children
Taken from Protocol for the Use of Anti-thrombotic Treatment in Children, for more information, see LHP
1
2
Check coagulation screen before heparin administration and record baseline APTT on the front of this chart.
Loading dose
Do not load if just stopped low molecular weight heparin (LMWH)
3
Pre-term neonates (< 35 weeks gestational age)
50units / kg over 10 minutes.
All other ages
75units / kg over 10 minutes
Infants < 1 year
28units / kg / hour
Children > 1 year
20units / kg / hour
Initial maintenance dose
4
Heparin adjusted to maintain APTT at 60 to 85 seconds, assuming that this
reflects an anti-FXa level of 0.35 to 0.70
APTT
(seconds)
Bolus, (units/kg)
Stop for (minutes)
Rate Change
(%)
Repeat APTT after
Less than 50
50
0
+ 10%
4hours
50–59
0
0
+ 10%
4hours
60–85
0
0
0
Next day
86–95
0
0
– 10%
4hours
96–120
0
30
– 10%
4hours
More than 120
0
60
– 15%
4hours
5
Check APTT 4 hours after start of heparin infusion and 4 hours after every change of infusion rate.
6
When APTT values are in therapeutic range, perform daily FBC and APTT and alternate day potassium.
REVERSAL OF HEPARIN THERAPY - to be prescribed on front of main drug chart.
Calculate the amount of heparin given
to patient over the last 4 hours. Break
the 4 hours down into 4 time zones
Amount of heparin that was
given to the patient
Dose of protamine for each time zone
of heparin
Calculate the dose of protamine for each time
zone, and then add up the amount to be given
(max dose 50mg max rate 5mg / minute)
1mg per 100 units heparin
0.5mg per 100 units heparin
0.375mg per 100 units heparin
0.25mg per 100 units heparin
Last 30 minutes
Previous 30 - 60 mins
Previous 60 - 120 mins
Previous 120 - 240 mins
Total:
Registered by Medicines Risk Management Group
October 2010
Reviewed
May 13 / Nov 13
Re-registered
Dec 2013
Next review due
Dec 2015
Pharm Ref No.
08/008 v2
Hypersensitivity reactions to
protamine sulphate may occur in
patients with known hypersensitivity
reactions to fish, or in those
previously exposed to protamine
therapy or protamine-containing
insulin therapy.
PU Ref No.
WPG656