PGCEE MDS 2022: Best route of heparin administration when IV line cannot be established is:

 # Best route of heparin administration when IV line cannot be established is:
A. Oral
B. Subcutaneous
C. Intramuscular
D. Sublingual

The correct answer is B. Subcutaneous.

Dosage: Heparin is conventionally given i.v. in a bolus dose of 5,000–10,000 U (children 50–100 U/kg), followed by continuous infusion of 750–1000 U/hr. Intermittent i.v. bolus doses of UFH are no longer recommended. The rate of infusion is controlled by aPTT measurement which is kept at 50–80 sec. or 1.5–2.5 times the patient’s pretreatment value. If this test is not available, whole blood clotting time should be measured and kept at ~2 times the normal value.

Deep s.c. injection of 10,000–20,000 U every 8–12 hrs can be given if i.v. infusion is not possible. The needle used should be fine and trauma should be minimum to avoid hematoma formation. Hematomas are more common with i.m. injection—this route should not be used.

Low dose (s.c.) regimen 5000 U is injected s.c. every 8–12 hours, started before surgery and continued for 7–10 days or till the patient starts moving about. This regimen has been found to prevent postoperative deep vein thrombosis without increasing surgical bleeding. It also does not prolong aPTT or clotting time. However, it should not be used in the case of neurosurgery or when spinal anesthesia is to be given. The patients should not be receiving aspirin or oral anticoagulants. It is ineffective in high-risk situations, e.g. hip joint or pelvic surgery.

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