Insulin and Levophed drips on cardiovascular unit - page 2

by heartnurse2012

9,330 Views | 41 Comments

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... Read More


  1. 1
    Oh my. Insulin, yes. Levophed, not happening. A patient on a Levo gtt is unstable by definition.

    As an aside though ... and something to think about in case your management brings up this point ... an ER nurse may indeed have a patient on one of those gtts AND 2-4 other patients at the same time. The flow is completely different, though.
    GrnTea likes this.
  2. 1
    As many stated, Levo is NOT safe. My additional point is...insulin gtt's can be VERY time consuming. I've had a number of patients who did not immediately stabilize and were hourly blood glucose tested and constantly titrated. That WITH levo with those ratios is crazy. Could risk mngt help? I would NOT want my family member on a unit such as that.
    GrnTea likes this.
  3. 1
    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!)
    GrnTea likes this.
  4. 3
    There's a reason Levophed's other moniker is Leave'em dead.
    Sugarcoma, GrnTea, and Esme12 like this.
  5. 0
    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.
  6. 0
    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.
  7. 0
    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.
  8. 1
    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.
    Esme12 likes this.
  9. 0
    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.
  10. 0
    Quote from heartnurse2012
    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!


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