Has anyone used Natrecor on their unit? - page 2

I work in a 33 bed telemetry unit, "stable" tele. The only drips we use are Dobutamine, Heparin, Cardizem. The physicians have decided to use Natrecor to treat CHF instead of Dobutamine. Currently... Read More

  1. by   sheilagh
    I have used natrecor many times on my Tele unit and after the initial VS Q5min X4 we monitor every 4 hours BP, but they are monitored so their pulse (which natrecor likes to drop, and which is usually the first parameter set for holding) is always monitored. The natrecor is usually an end stage CHF tx when nothing else is pulling the fluid and I have to say when I see someone almost drowning at 7pm when i leave and by 7am when i get back they can talk and even ambulate a little it is amazing stuff....hope this helps.
    BTW check carefully with your pharm about any pushes or flushes, natrecor is NOT compatible with most IV diuretics and heparin, and a whole host of others often seen with CHF...........SMILE
    P.S our ratio is supposed to be 5:1 but lately it's 6:1...sigh
    Last edit by sheilagh on Dec 27, '04
  2. by   SCNuttyMeg
    I work on a 28 bed telemetry floor and we have a ratio of 1:5 pts. We do natrecor gtts a good bit. Seeing I just got home from work after 15 hours I cant recall us doing any more frequent monitoring than we do with our cardizem etc. I personally would rather start a natrecor gtt than a cardizem gtt. Ive seem to have more problems with cardizem bolus and gtts. We might get them a lot where i work due to we have a natrecor clinic that our pts come to on outpatient basis for CHF management. Speaking of gtts we are about to start insulin gtt on are preop cabg(now thats a little scary to me)

    Good Luck
  3. by   kfeem1
    Quote from DutchgirlRN
    I work on a Med/Surg/Telemetry floor and our ratio is 6:1 . We have Natrecor gtts frequently. We are not allowed to initiate the gtt nor bolus the gtt, that has to be done in CCU. Once they've been on the gtt for 4 hours they can come to the floor. The vital signs are Q 4 hours. So far no problems. I appreciate all the information. I am going to pass it on to my nurse manager. Merry Christmas !!
    I wouldn't fell safe only monitoring vital signs Q 4 hours on a patient on Natrecor drip. I would at least monitor vital signs Q 2 hours to feel safe.
  4. by   staceylynn
    Natrecor is ok to use on a tele unit. It not much different then dobutamine. The only problem is that it can cause hypotension, which usually occurs after 24 hr. But if you take on this drug, they'll keep adding more drugs!
  5. by   Marnaby
    I work on a 12 bed cardiac stepdown unit (4:1 days, eves, and nights) and Natrecor is the most popular gtt next to Heparin here. I float between this floor and a 32 bed post-procedure (mostly caths) floor. Both floors take Natrecor and we bolus and initiate the infusion. Vitals are monitor every 15 minutes for the first hour. Then hourly for about 4 hours. When the pt is deemed to be stable the vitals are done every 4 hours.

    Strict I's and O's and fluid restrictions are very important in these types of patients. I heard that each bag costs closer to $750. The pharmacy is very strict about practically running the bag dry before getting another one.

    Natrecor is just a way of life for me lately! Hope this helps.
  6. by   zacarias
    Quote from staceylynn
    Natrecor is ok to use on a tele unit. It not much different then dobutamine. The only problem is that it can cause hypotension, which usually occurs after 24 hr. But if you take on this drug, they'll keep adding more drugs!

    I agree that it's OK to use on a tele unit. Yes it's a serious drug but it has helped so many people. It is quite natural that Natrecor be used on a tele/stepdown unit as long as each nurse is trained in the drug, knows the protocols, etc...
  7. by   candyndel
    Natrecor is perfectly fine for tele as well as M/S. It is now being used in CHF clinics for outpatients, as well. It doesnt require a monitor b/c it rarely causes arrhythmias (unlike dobutamine). You just have to watch for symptomatic hypotension. It is a synthetic naturetic peptide that aides the pts own endogenous BNP to counteract the RAAS, the culprit behind CHF.
    Email me if you need more info....


    OTE=maryangel]I work in a 33 bed telemetry unit, "stable" tele. The only drips we use are Dobutamine, Heparin, Cardizem. The physicians have decided to use Natrecor to treat CHF instead of Dobutamine. Currently if a patient is on this drip, they have to be in the unit for frequent vital signs, closer monitoring, etc. Our cardiologists want us to give the drip on our floor. Our nurse/pt. ratio is 1:5 or 6 on days and 1:8 or 9 on nights. Has anyone used this drug on their unit? and if so, do you think the ratio we have would be acceptable? Thanks for any input.[/QUOTE]
  8. by   candyndel
    No- its very different than dobutamine...its a synthetic peptide, not an inotrope!! Also, the hypotension almost always occurs within the first 4 hours and the pt shouldnt be on it for more than 24 hours. There really should be an automatic stop on it (24 hours) so it doesnt get abused. The nurse should assess the pt's status and not just hang another bag! When you have pts on it for too long, the pharmacy is going to outrule it and pts that really need it wont be able to get it!!



    QUOTE=staceylynn]Natrecor is ok to use on a tele unit. It not much different then dobutamine. The only problem is that it can cause hypotension, which usually occurs after 24 hr. But if you take on this drug, they'll keep adding more drugs![/QUOTE]
  9. by   rwall
    Quote from DutchgirlRN
    I work on a Med/Surg/Telemetry floor and our ratio is 6:1 . We have Natrecor gtts frequently. We are not allowed to initiate the gtt nor bolus the gtt, that has to be done in CCU. Once they've been on the gtt for 4 hours they can come to the floor. The vital signs are Q 4 hours. So far no problems. I appreciate all the information. I am going to pass it on to my nurse manager. Merry Christmas !!
    Do you happen to have this Policy written? If you do, I would be interested in seeing it. That would be helpful.
  10. by   candyndel
    Sure. email me and i'll send u a copy


    Quote from rwall
    Do you happen to have this Policy written? If you do, I would be interested in seeing it. That would be helpful.
  11. by   PrncessK
    Quote from DutchgirlRN
    I work on a Med/Surg/Telemetry floor and our ratio is 6:1 . We have Natrecor gtts frequently. We are not allowed to initiate the gtt nor bolus the gtt, that has to be done in CCU. Once they've been on the gtt for 4 hours they can come to the floor. The vital signs are Q 4 hours. So far no problems. I appreciate all the information. I am going to pass it on to my nurse manager. Merry Christmas !!
    I work on a 32 bed Tele unit and we have patients on Natrecor all the time. We do the bolus and do the drips and our policy is the standard vitals q4h.
  12. by   ageless
    Use cautiously in ESRD patients. According to them it is ineffective. Our nephrologists hate it and cancel the order written by another physician everytime.
  13. by   Pill Hoarding Hussy
    Quote from maryangel
    I work in a 33 bed telemetry unit, "stable" tele. The only drips we use are Dobutamine, Heparin, Cardizem. The physicians have decided to use Natrecor to treat CHF instead of Dobutamine. Currently if a patient is on this drip, they have to be in the unit for frequent vital signs, closer monitoring, etc. Our cardiologists want us to give the drip on our floor. Our nurse/pt. ratio is 1:5 or 6 on days and 1:8 or 9 on nights. Has anyone used this drug on their unit? and if so, do you think the ratio we have would be acceptable? Thanks for any input.

    i work on a step down (before that a 32 bed "stable" tele floor) both floors have1:4 on days, step down has 1:4 or 1:5 nocs floor has 1:6-7 on nocs. majority of natrecor pts go to step down. q 15 min vitals while initiating the gtt, or increasing the dosage- then decreasing to q1 hr, q4. it's your nursing judgement about how the pt is tolerating the gtt. if they're hypotensive we may add dopa to the mix, depends on the pt' baseline sbp and how low nursing and the med team is comfortable allowing the pt to drift/if they are diuresing, etc. 1:6 sounds like a lot to handle with a pt of the intensity the usually requires this gtt.

close
Has anyone used Natrecor on their unit?