Has anyone used Natrecor on their unit? - page 3

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   Pill Hoarding Hussy
    Quote from 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!!

    what is the reationale for pts only being on natrecor for 24 hrs? yes, the oder does expire, but that does not necessarily mean that they don't have any more fluid to pull off. we routinely have pts on this gtt for 3 or so days... and it works for those who come 15 lbs over dry wgt.


    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]
  2. by   hui126
    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've used natrecor on the floor before. if the patient is stable and has been on the drip for awhile, you just have to make sure that you have another bag ready when the first one runs out, take frequency vitals. sometimes it's tricky if you have to start the drip, it's more tricky because of the loading dose and frequency vitals - then I would question the nurse to patient ratio. Hope this helps.
  3. by   snakeRN
    i work in a ccu and most of the time Natrecor infusions are done on the telemetry floors. However, with this drug, there does need to be and increase in the frequecey of the patients vital signs, as this drug can cause marked hypotension. The drug is an excellent choice for the CHF patient cause it increases the output of the heart, thereby reducing fluid buildup in the lungs. Hope this helps......Snake
  4. by   schroeders_piano
    Quote from 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).
    [/QUOTE]

    Natrecor doesn'ts casue arrhythmias but it can cause a substantial drop in heart rate. My facility requires q 15 minute vitals and constant telemetry monitoring for any patient on Natrecor. I have seen patient who have been on the drip for 2 hours with no problem and then suddenly the patient's blood pressure has taken a dramatic nose dive down. It is a very serious drug that requires frequent monitoring and assessment.


    Schroeder
  5. by   candyndel
    Natrecor usually doesnt cause bradycardia, as tachycardia and hypotension are its 2 most common SE's. Its a POTENT vasodilator which is why it shouldn't be used with NTG, nipride, etc. It can, however, cause VT, but the incidence of that is even less than the use of dobutamine.
    Natrecor is currently being used in homecare & outpt HF clinics- all without cardiac monitors. It's not for every patient with HF, but works great for ADHF with SOB at rest. (Remember though, it has weak diuretic properties so modest amounts of diuretics are needed.)

    A 24-hour automatic stop is a recommendation by Scios so the clinician (the bedside RN) can assess the need to continue its usage. If the pt is still congested (wet, fluid overloaded...), by all means, hang another bag!
    But people were just rehanging it for days without assessing the pts volume status; and thats where the overuse begun. This misuse of the drug puts it under much financial scrutiny and inappropriate rationing.
    In its clinical trials, there was successful reduction in PCWP and dyspnea after only 3 hours in 90% of the pts.
    Treat to euvolemia!!!


    [/QUOTE]
  6. by   bemory
    my floor specializes in chf so there is not a day that goes by that I dont give natrecor. I work nights with usually 5-6 patients and I have had no problems. It may be a little time consuming at first because of the frequent vital signs but after 2 hours they are monitored q4. We have propacks (bedside bp machine) for frequent vital signs and they will show the bp on our telemetry machines up front. The big concern is what other medications the patient may be taking, and what the doctors set their parameters at. Some cardiologists want the med continued even if pt sbp is less then 90, others want to be notified immediately. I had one MD who cut the dose of natrecor to a whopping 1.5 an hour instead of stopping it. Another thing also is that usually the medicine is given to patients who come in for the medicine and so they usually will need not a lot of maintenance. I hope this sort of helps
  7. by   feebs
    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 am an RN and was working on a similar unit, 33 beds, med surg tele, step down. Got the order on a Sunday, very busy, had to give Natrecor but did not have any info. I called ICU, asked around, no one could tell me how to start the infusion, just give a bolus, and go slow. I finally got pharmacy to give me some guidance, but it was sketchy.(They are not nurses)
    The charge nurse told me to give a bolus,(taking it out of the bag that pharmacy sent up) do it slow iv push and monitor the patient blood pressure, o2 sat, etc..
    I quit that job, soon after, partially of the lack of protocol for things like that. I had been put in several situations where I was flying by the seat of my pants, risking my license, my patients.
    I now am happy on a similar unit,at a different facility where we have a Natrecor policy, printed out like the forms you use for Heparin. It is a doctor's order form, with parameters. that the dr has to check off, like on the heparin dosage form.
    For example, the patient has chf, is short of breath, with dyspnea, BNp elevated, etc. The BP should be above 90, they sould not be on other IV vasodilators like Nitro, and you should stay with them for a while after giving the bolus dose, slow iv push If you have a Dr order for that. It needs to be a dedicated iv line, on a pump and probably checked by 2 Rn's like other dangerous drugs,(ie Heparin, insulin,)
    It is being ordered more and more for CHF. You can look up Natrecor or naseritide on the internet for drug info. and ask your manager to get a written policy/protocol.
    good luck, feebs, alias deb
  8. by   zacarias
    The hospital I was working at was recently considering a move to stop using natrecor as the efficacy is doubtful.
    I can't imagine natrecor being used in place of an inotrope like dobutamine.
  9. by   WOLFE
    I work on a surgical stepdown tele floor....open heart/trauma/surgical...we hang natrecor...special protocol in regards to the med...may only be prescribed by a cardiologist...may be hung by an RN that is tele, acls, and titratable drug certified...exclusion for natrecor...pt in cardiogenic shock or other states of shock, low cardiac filling pressures or low outputs, sbp less than 90...do not admin with tridil, nipride, iv ace inhib...do not use with heparinized line or heparin coated cath...also incompat with insulin, bumex, lasix, vasotec, hydralazine, edecrin...iv bolus over one minute...then infusion...may be hung for 24 hrs...vs as follows...bp q 15 min for one hr...then q 30 min times one hr...then q hr for two hrs...then q 4 for the duration of infusion...intake and output must be documented...daily weight...if sbp less than 90 or pt symptomatic stop infusion and notify md...we also ensure pt on tele, monitor tech notified...crash cart nearby...and two RN's check entire order from md order to concentration, pt id, drip rate, vs...etc...maybe a bit over kill...but we don't think so...now nurse to pt ratio 1:6...and i can also have any or all of the following combination...chest tubes, pacing wires, external pacers, ngt, vents, heparin, cardizem, dobutamine, dopamine, integrillin, amiodarone, vasotec, nitro...out of all the drips i hang natrcor is the least favorite...it is a very nasty drug...benefical to pt...but needs very close observation.
  10. by   WOLFE
    sorry...one more tid bit...stay with pt while iv bolus and first 15 min of drip...both on pumps.
  11. by   mart18642
    I think this drug should be used in an area of low nurse-patient ratio, and this is the reason why, I have been a nurse for 10 years work in cardiology most of the time, I got this job in a 40 bed tele- med-surge floor one day of orientation to the floor, just this Saturday I took a load of 6 patients one with this drip, another hypovolemic with b/p 85/35 and h/h dropping and the rest with others with high needs. I have to make a decision between my hypo- and the drip, so I figured I start stabilizing the hypovolemic for obvious reasons, infuse RBCs highly needed and monitored very closely for 2 h until I saw she was stabilized and her B/P stable. Finally I went to check on my drip(9:30- no one even check to see why my IV was beeping)when I heard that noise I immediately went to my Pt's room and was his, the Iv was off his hand ( also I had a peripheral line in place) and the drip was totally gone, the rate on that drip was 8 ml/hr , so I thought may be they d/c this drip while I was with this other patient(not clearly thinking yet), then I got call to do some thing else , by the time I was done another call came to see Dr. at the desk and he questioned me why the drip was off this patient, my honest answer was that when I went to check it was already off his arm; this was a big issue with the unit coordinator and got me to the point that I'm putting my 2 wks on Tuesday, this is a delegation issue, I'm new to this floor. Later on I found out that the patient did not want the IV on , so of course he took it off, he which he denied afterwards; I already knew that he had a hx of non-compliance in the chart and the dr confirmed this at his bed side ; I think any critical drip that have to be monitored closely need to be delegated correctly, with less patients, according to acuity. The patient's drip was d/c the very next day and no harm was done to patient, but potential for it, yes...............and the moral and respect for the unit coordinator that runs this unit totally destroyed.

    Well I needed to take this incident off my chest
  12. by   All_Smiles_RN
    Quote from zacarias
    The hospital I was working at was recently considering a move to stop using natrecor as the efficacy is doubtful.
    I can't imagine natrecor being used in place of an inotrope like dobutamine.

    Studies suggest an increase in mortality associated with natrecor usage. Increased Risk of Mortality with Nesiritide for Decompensated Heart Failure
  13. by   Indy
    We have one cardiologist out of many who seems to adore using Inocor on his well-compensated CHF patients, and even he doesn't order natrecor very often. It takes me a solid hour devoted to that one patient if they need the drip started, and it's q15 min vitals for an hour or two, q2 hour vitals for the rest of the drip.

    We did have one lady who became dependent on natrecor just to breathe. Very sad case, she was 340 pounds, but actually walked on her own some, came in, natrecor gtt, hypotension and hello ICU bed for a while. A few days later they want to transfer her back to tele unit... no problem, we get the room ready and then hear from them that they can't d/c her natrecor drip, every time they try she becomes more unstable, so they kept her in ICU. I didn't hear how she did after that, but it didn't sound like a good prognosis.

    We use a wide variety of drips on my unit: heparin, cardizem, amiodarone, inocor, natrecor, integrillin, reopro, (usually integrillin and reopro are hung in cath lab) insulin very rarely, dopamine, dobutamine, primacor, and I can't think of any others at the moment. 1:3-4 on days, night ratio is 1:4-6. It can get pretty hairy even with stable patients to have to start some of these drips. My least favorite would be dopamine because the patients I've had are so darn delicate with what dosage they can take, you get just a half microgram/kg/hr over what they do well with, and there goes your night. Dobutamine has a similar protocol, but I've only seen one bad night with that med, those usually work okay, just very time consuming.

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Has anyone used Natrecor on their unit?