Insulin and Levophed drips on cardiovascular unit

Specialties Cardiac

Published

This is something new coming to us nurses on the floor, we have 4 pts each but somedays it can be 5 pts. We have an A side which is the more critical and post op day 1 CABG's then the B side which aren't as critical. Total of 48 rooms.

These drips are usually managed in the ICU, any tips or points to bring up in the future unit meetings? Many of us are worried.

Specializes in Geriatrics, Transplant, Education.

Levophed?? No way, no how would I do that outside of an ICU setting...that's asking for trouble.

Insulin gtts I have done on my med surg floor--hourly BGs are no fun but the computer algorithim we utilize to calculate our rates is very user friendly and makes the whole process easier. Definitely not my favorite though when I have 3-4 other patients. (Recently had an assignment where I had one pt on an insulin gtt and a very recent post op liver-kidney transplant plus two other reasonably stable (thankfully!) m/s patients...busy busy night!)

Up Vote Up Vote ×
Specializes in CRNA, Finally retired.

There's a reason Levophed's other moniker is Leave'em dead.

Up Vote Up Vote ×

Subee, you beat me to it. I was gonna say, "They still use leave-'em-dead?" Ah, those nicely mottled limbs, so festive this time of year.

Up Vote Up Vote ×
Specializes in Trauma/Tele/Surgery/SICU.

For the insulin drips I would specifically ask management how they plan to address the Q1 accuchecks. Will this be shared between PCT and RN or will the RN be responsible for all of them? In my opinion having 5 patients and even one on an insulin drip is very difficult! Will the ratios be reduced for the RN who has an Insulin drip patient? How do they plan to manage multiple insulin drips? Will one nurse get 3 or 4 of these? Finally do they have a protocol in place for management of the insulin drips that includes hypoglycemia? My facility does not and we have to call the doc every hour, not at all feasible with 5 patients!

For the Levo I would specifically ask the management if they are out of their flipping minds. There is no such thing as a stable patient on levo period. This medication must be managed with central access due to the high risk of necrosis with extravasation. You must have an arterial line to accurately measure the patient's BP. You really should have a vigileo so you can measure other hemodynamics, for post-op patients especially. Finally there are a multitude of side effects that require astute monitoring of the patient, urine output, and their ekg. Something a nurse with 4 other patient's cannot do safely! I would absolutely refuse a patient on levophed outside of an ICU/ER.

We had a similar issue at the facility I used to work at. The caveat was the patient's on drips could go to the floor as long as the drip was not being titrated. This automatically excludes levo which must be titrated both for effect and to get the patient off ASAP.

Up Vote Up Vote ×
Specializes in CCU, CVICU, Cath Lab, MICU, Endoscopy..

Titrating pressors its not safe outside of ICU. They need invasive lines plus VS are monitored q15 min. Unless they reduce your other patient work load dramatically then ICU is the answer. I have seen insulin gtts on stepdown but the CNA its assigned to blood glucose checks.

Up Vote Up Vote ×
Specializes in ER, progressive care.

Insulin could be done with the ratio on your floor, but it can be difficult. Blood sugar checks need to be done at least Q1H, sometimes Q30min. Levophed would be unsafe at that ratio, IMO. There's a reason why ICU nurses deal with all of those potent vasoactive drips and they have a ratio of 1:2 (sometimes 1:1 or 2:1!). Even with monitors in each room and central monitoring, I don't think Levophed has a place outside of the ICU. Patients who need levo belong IN an ICU.

Up Vote Up Vote ×

Thank you all for the input. We have an hour "training" on all this next week. Just 1 whole hour. Turns out that our 2 endo docs had no input on this or knew about insulin drips coming to the floor.

Turns out our new team leader who we all agree shouldn't of got hired due to being friends with the "click" on the floor. One of the heart surgeons was pushing this matter before and didn't get it. Now she got her way. I feel she doesn't care about her staff at all and will do what makes the surgeons happy, and if something does happen we will be sent down the river without a paddle.

Up Vote Up Vote ×
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Thank you all for the input. We have an hour "training" on all this next week. Just 1 whole hour. Turns out that our 2 endo docs had no input on this or knew about insulin drips coming to the floor.

Turns out our new team leader who we all agree shouldn't of got hired due to being friends with the "click" on the floor. One of the heart surgeons was pushing this matter before and didn't get it. Now she got her way. I feel she doesn't care about her staff at all and will do what makes the surgeons happy, and if something does happen we will be sent down the river without a paddle.

((HUGS))...I'm sorry. The insulin gtts ok Levo! NO!

Keep us up dated!

Up Vote Up Vote ×
Specializes in PCCN.

That's like one of the cards docs wanted us to take balloon pumps on a stepdown floor. Seriously- while my two confused climbing out of bed medical patients are trying to be kept safe ????and my other 3 pts are prob post PCI's? Ain't happening. Luckily, the idea has sort of faded away for now. But if it comes up again- it will be met with much disapproval .

I guess if they push this crap on you- you might as well consider going to the ICU- at least you'll have the right ratio's and get some good training hopefully. Ihave thought about this option before- if you cant beat em, join em.

Some of the foolishness management is putting on us RN's. Somedays I feel like handing in my license at the door"here ya go"

Up Vote Up Vote ×
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
That's like one of the cards docs wanted us to take balloon pumps on a stepdown floor. Seriously- while my two confused climbing out of bed medical patients are trying to be kept safe ????and my other 3 pts are prob post PCI's? Ain't happening. Luckily, the idea has sort of faded away for now. But if it comes up again- it will be met with much disapproval .

I guess if they push this crap on you- you might as well consider going to the ICU- at least you'll have the right ratio's and get some good training hopefully. Ihave thought about this option before- if you cant beat em, join em.

Some of the foolishness management is putting on us RN's. Somedays I feel like handing in my license at the door"here ya go"

A balloon pump? On the floor???? :banghead: What are they thinking.....if only the public really knew.
Up Vote Up Vote ×
Specializes in ICU.

If they are wanting to send balloon pumps to the step down & Levophed gtts to the floor, what exactly qualifies a patient for ICU status in your hospitals??

Up Vote Up Vote ×
Specializes in PCCN.

^^^ that's a good question.

All I know, is that when we get a pt that MD wants in ICU, they are always so full that they have to kick someone out to make a bed for them, and the pt has to wait until that pt has moved.

Seriously- If they opened up another ICU, Im sure they would have no prob. filling the beds

I guess this is what they mean when they say pts are getting sicker and sicker.

Up Vote Up Vote ×
+ Add a Comment