Protamine can be quite deadly in post procedural patients.I will try and attach article.

It would help if you could tell us the technique being used, and how much heparin you are concerned about.

My first thoughts are to avoid protamine when possible.. I've just seen so many bad reactions. I would prefer bed rest and a pressure dressing. I am getting tired of hearing about cost containment, days in hospital, etc We should focus on the patient.

Thank you for your response.  The specific patient population I am referring are patients who have undergone radiofrequency ablation for left sided arrhythmia: AF, AAFL, PVC's, VT, etc.  Prior to the transeptal puncture - the pt is bolused with heparin with the endpoint being an ACT of 300-400 sec. Prior to sheath removal, the ACT needs to lowered to 160. The issue is not only monetary - although this is part that gets the attention of administration.  From a patient care perspective, longer time to sheath pull means longer duration of total bed rest. After 4 hours + on the table for a procedure, then 2-3 for the ACT to come down via 1/2 life, and 4-6 hours of bedrest post sheath pull - this can lead 10-12 hour of flat, bedrest. For patients with back issues, obese patients - etc, this can be problematic. Also, development of hematoma puts them at risk for post-procedural infection and adds additional pain considerations to the equation. 

I will read the article regarding protamine reactions - as I have encountered many that indicate that the incidence of reactions is nominal. 

Thank you again for your input - 

K

Left sided EP procedures require Heparin. 3000 U heparin can be given in the femoral arterial sheath and an additional 2000 U can be given after trans septal puncture. Protanine reversal is not required unless there is some complication like perforation or tampoade.