Implementation

• High Alert: Accidental overdosage of antiplatelet medications has resulted in patient harm and/or death from internal hemorrhage or intracranial bleeding. Have second practitioner independently check original order, dosage calculations, and infusion pump settings

• Do not use preparations of abciximab containing opaque particles

» Avoid nonessential use of arterial and venous punctures, IM injections, urinary catheters, NG intubation, NG tubes, and automated blood pressure cuffs during therapy. Avoid use of noncompressible sites (subclavian or jugular veins) for IV access. Use heparin locks for drawing blood. Use a chemical tape remover when removing dressings

» Restrain affected limb in a neutral position and maintain complete bedrest with the head of bed elevated to at least 30° while the femoral artery sheath is in place

» Heparin should be discontinued at least 4 hr prior to removal of the femoral artery sheath

» Apply pressure to the femoral artery for at least 30 min with manual compression or a mechanical device for hemostasis following sheath removal. Apply a pressure dressing following hemostasis. Maintain bedrest for 6–8 hr following sheath removal or discontinuation of abciximab, whichever is later

• Direct IV:
Do not shake the vial. Withdraw the amount of abciximab needed for bolus through a sterile, nonpyrogenic, low-protein-binding 0.2- or 0.22-micron filter into a syringe

• Rate:
Administer as a bolus injection 10–60 min before the start of PCI or in patients for which PCI is planned within the next 24 hr

• Continuous Infusion:
Withdraw 4.5 ml of abciximab through a sterile, nonpyrogenic, low-protein-binding 0.2- or 0.22-micron filter into a syringe. Inject into 250 ml of 0.9% NaCl or D5W to make a solution with a final concentration of 35 mcg/ml. Do not shake. Discard the unused portion in the vial and any of the solution unused at the end of the 12-hr infusion. Store in the refrigerator; do not freeze

• Rate:
Infuse at a rate of 17 ml/hr (10 mcg/min) for 12 hr following PCI, or in patients for which PCI is planned within 24 hr, for 18–24 hr, concluding 1 hr after PCI. Administer via infusion pump through an in-line sterile, nonpyrogenic, low-protein-binding 0.2- or 0.22-micron filter

• Additive Incompatibility:
Administer in a separate IV line; do not add other medications to infusion solution

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