Question about Cardizem Drip... - page 2

by al7139

49,655 Views | 14 Comments

Hi, I work on a tele/med unit, and have had several pts on Cardizem gtt's since my first day. Yesterday, I received report on a pt who originally was admitted for "sepsis" and was stable when I left the previous night. My... Read More


  1. 0
    Quote from FENT
    The doctor ordered cardizem drip for a post op pt VS 130/88 HR 68 R20
    I follow the doc order and started the drip but the charge nurse got mad WHY?????
    What was the MD's reason for ordering the gtt to begin with?
  2. 0
    To the OP, it sounds like you used your best judgment and that was a good call.

    On our unit, we don't even have techs monitoring the ...well...monitors. It's us nurses who have to keep a look out for our patients and each others'. And the dilt/cardizem gtt patients are always being watched FIERCELY. It's kind of an unspoken policy on our floor that once they have a heart rate consistently in the 70's, the gtt gets turned off.

    (Incidentally, I have no idea why someone would order a dilt gtt for a pt whose HR is 68...)

    As for patients vagal-ing out, that's happened to us too. Most of the time we don't let even our dilt gtt patients get out of bed to urinate or defecate. We've just found their BP's and HR's to be too labile.
  3. 0
    One thing that's a common procedural error is paying attention to the HR number on the monitor. At our place, that's the HR of a sliding 6-second window. But when a MD asks for a HR, he's asking for BPM (beats per minute), and that's the standard, measuring HR over a 60-second period.

    Now if you will look for the HR graph in the pt's details, you will see the HR for a sliding 60-second window. Yeah, your tech just called you in a panic because he saw 160 for a moment on the screen, but look at the true HR--might be 110, 90, 130, whatever. So rule #1 is: don't panic. And don't tell the MD the pt's in the 160s if you want appropriate orders. If there's any way to measure BP too and have it sent to the screen, do it, especially in the first hour of initiation.

    Second, when you catch a new pt from the ER, always check the med admin record. Always. Sometimes you'll find they've been given a beta blocker just before they came up, and here you have a stat order for a cardizem push and drip. Again, check the HR over 60 seconds. Not too bad, say 130 or less? Wait a while to assess the effect of that beta blocker on HR/BP, especially if they're naive to cardiac meds.

    But really it's not a good practice to give a pt a PO beta blocker, then put them on a cardizem push/drip. Google it. If their HR is high enough to begin with, start with the cardizem and hold the blocker. Cardizem has a short half-life compared to PO beta blockers, which might hang in there 12 hours with no way to reverse the effect.

    Third, communicate with the MD. Compare notes. Suggest. Negotiate. Don't guess. When they wrote the orders, they didn't have as much information as you now do. Help 'em out. Sometimes, even if they aren't willing to forgo the drip, they'll d/c the push and let you start at a lower rate. And, um--we ARE talking about afib and svt, and not sinus tach, right? Saw that twice last week, cardizem drip/push for mild sinus tach. We got 'em d/c'd.
    Last edit by anonymurse on May 11, '11
  4. 0
    hmmm i m still stuck on the OP writing about an 8 second pause the patient had...did thisperson get a pacemaker??? or just hang around on a cardizem gtt.
    we titrate that gtt down pretty fast once in SR or rate controlled and on PO cardizem--soemtimes the gtt comes off before the PO dilt.
    btw to the post who pushed 24mg of cardizem that seems like a *boatload* of cardizem to push doesnt it? ive seen as high as 18mg and i knew that pressure was gonna bottom out shure nuff it did.
  5. 0
    Quote from surferbettycrocker
    hmmm i m still stuck on the OP writing about an 8 second pause the patient had...did thisperson get a pacemaker??? or just hang around on a cardizem gtt.
    we titrate that gtt down pretty fast once in SR or rate controlled and on PO cardizem--soemtimes the gtt comes off before the PO dilt.
    btw to the post who pushed 24mg of cardizem that seems like a *boatload* of cardizem to push doesnt it? ive seen as high as 18mg and i knew that pressure was gonna bottom out shure nuff it did.


    No, its not a *boatload* when standard bolus before a drip are 20mg to 25mg..look it up it a drug book =)


Top