Underdosing or Overdosing Heparin—A Nurse’s Nightmare?

December 18th, 2009. By janem

I wouldn’t want to be a nurse administering heparin and I wouldn’t be surprised if seasoned nurses are reluctant to inject their patients with the blood thinner.

Most everyone is familiar with the incident that happened with actor Dennis Quaid’s twins: in 2007 a nurse picked up the wrong bottles of Heparin and the newborns were given an overdose that almost killed them. The “tired” nurse was blamed, and now Quaid has launched a campaign for better bottle-labeling systems. Wouldn’t better labeling be the responsibility of the drug manufacturer?

In October, US officials announced that heparin’s potency will be reduced by about 10 percent. So some patients will receive a higher-than-usual dose or number of units of heparin. (Sounds like good news for the manufacturer-unless the price of heparin drops by 10 percent. ) According to the FDA, recommended doses of heparin described in the drug’s label have not changed, and it does not recommend that clinicians increase a patient’s heparin dose to compensate for the reduced potency. Does that mean a patient has a higher risk of blood clots?

Researchers at the University of Oxford say that the risk of having a potentially fatal blood clot after surgery is higher and lasts for longer than had previously been thought. What if a patient isn’t given enough of the low-dosage heparin?

It’s very confusing.

According to HealthDay News, the decrease in potency will make it easier to spot impurities. The new lots will be identified by either the letter “N” placed next to the lot number or expiration date (three manufacturers) or a numeric code (one manufacturer). Got that?

Officials say that the correct dosing of heparin “has always been highly individualized and requires intense monitoring, which is a protocol that will remain in effect.” Dr. Dwaine Rieves, director of the FDA’s Center for Drug Evaluation and Research Division of Medical Imaging and Hematology Products, said, ”The use of heparin is closely tied into monitoring and doses adjusted based on that.”  If I were a nurse, I’d be thinking about Quaid’s twins who were given too much heparin; I’d be thinking about amputee James Bradley, who was given too much.

Tags: Heparin

This was posted on Friday, December 18th, 2009 at 8:28 pm and is filed under Drugs/Medical . Feel free to respond, or trackback. Read our comments policy.