Date of Award

Spring 5-2021

Document Type

DNP Project

Project Team Faculty Member

Dr. Kevin Stein

Project Team Faculty Member

Dr. Mary Zerlan


Heparin administration, interoperative guidelines, activated coagulation guidelines, percutaneous interventions, peripheral vascular surgery, carotid endarterectomy


Unfractionated heparin is administered to provide anticoagulation for the prevention of thrombosis and ischemia during vascular surgery. The intraoperative goals of heparin administration are the achievement of adequate anticoagulation and maintaining a steady-state plasma concentration throughout the procedure to prevent thrombotic events. Due to patient variation in heparin sensitivity, the standard within vascular surgery is to obtain the intraoperative activated clotting time (ACT) as a means of monitoring heparin activity and guiding dosing regimens. Measuring the intraoperative ACT allows for evaluation of the intrinsic pathway to assist the provider in achieving a steady-state heparinization with high-dose heparin administration.

To reduce adverse events associated with intraoperative heparin administration, a Level I trauma center in the Midwest implemented a reference for heparinization during non-cardiac vascular surgery. The reference served as a tool for on-call anesthesia providers who did not routinely deliver care for non-cardiac vascular surgeries. The tool provided guidelines for initial heparin dosing, activated clotting time goals, and intervals for ACT assessment. Following a two-month implementation period, providers were given one month to complete a post-implementation survey to collect their perceptions on the effectiveness of the intraoperative reference tool. The data obtained from the survey was utilized to determine reference tool applicability, provider satisfaction, and barriers to implementation. The overarching goal of the project was to obtain greater than 90% satisfaction among on-call providers surrounding reference tool use for non-cardiac vascular surgeries. Unanimously, the reference tool was categorized as both thorough in its content and an easy-to-use cognitive aid. Ninety four percent of providers felt confident in their ability to implement the tool.

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