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 report today was that the day shift called a "MRT" on her because she suddenly converted to A-Fib from NSR, and was flushed and "not quite right." Keep in mind in my facility a "MRT" stands for "Medical Response Team" and is made up of a team of nurses, respiratory therapists, the PCS, and if needed, an MD and an anesthesiologist. It's for when a pt is "not OK" but not coding.
The MRT team, after calling the pts MD and consult with cardiology put her on a Cardizem drip at 10mg/hr.
Previous to my shift the pt had an 8.8 second pause, then converted to sinus brady, then back to a-fib.
When I got report, the pt had actually converted back to sustained sinus brady, but was having pauses, and was also bradying down to the 30-40's briefly at times.
I called the MD first thing to tell him what the pt was showing on the monitor, because I have always been taught that side effects of a Cardizem drip can include bradycardia, and AV block (which could account for the pauses), but the other nurses did not seem that concerned even though I looked it up in our units IV drug reference to confirm.
When I talked to the MD, he had me decrease the drip to 5mg/hr for 1 hour, then D/C the drip.
I talked with the tele monitor to aske them to watch this pt closely (since I had 6 pts and could not watch the tele all the time), and explained to them that the pt was on Cardizem, and was now off of it, and I wanted to know if the pt continued to have the pauses and brady after the drip was D/C'd.
Turns out I was right, and after a few hours off the drip, the pt maintained a HR in the 60's and no pauses. I was surprised at how much my tele monitors knew about drugs, etc.
The pt remained asymptomatic, and at my offgoing report, I was able to tell the nurse that the pt was stable, but that the monitors would be on the lookout for anything abnormal.
Sorry this is so long, I guess the bottom line question is do you other cardiac nurses see reactions to Cardizem often similar to my experience? Most pts I have had on this drip do fine, and convert to a NSR, without these side effects.
Is this frequent? Or rare?
May 11, '11
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