titrating cardizem

We manage all of the drips that you describe, but our ratio is 4-5:1, and we do not titrate anything other than nitro and cardizem. Both have to have parameters set by the MD, and we won't go above 50mcg of nitro. Heparin dosages are managed by pharmacy at our facility, amio drips are managed by protocols, and after the bolus the integrillin will hang for a prescribed time and doesn't need titration. Dopamine and Dobutamine are a different matter. We will start the drips on the floor and monitor pts for their initial reaction over the first hour. We have strict limits on how high we will take the gtts, and we will not accept orders to titrate the gtt. We accept "renal" dosing only, and if the patient requires frequent orders from the doc to change the rate to keep vss, then they have to go to the unit. The docs hate this because they already see us as an enormous, cost effective ICU. Since we let them start the gtts, they want to make us manage them, and we just don't have the time to safely do that. I don't know how many times I have heard physicians say that they will transfer, since it is merely a staffing issue. YES its a staffing issue, because your patient is really a 1:1 and has been for the last 24 hours! Argh

on our tele unit we are 5:1 pt ratio- we do take cardiazem gtts and titrate but not greater than 20gtt/hr- we take dopamine gtts but no titration,renal dose only.lasix gtt we also titrate- all other gtts go to icu

I'm currently working on a cardiac gtt policy for our Telemetry/SDU. Do any of you have cardiac gtt policies or the criteria you use to determine what you take, when they go to the unit etc.?

We start, titrate and d/c our Cardizem gtts as well. The MD's typically place computerized orders to tell us when to titrate. For example: titrate to HR <50 >110, SBP >/= 100. We usually titrate the gtt by 5mg/hr (5ml/hr). Our maximum rate for Cardizem on our floor is 15mg/hr. If they need to be titrated higher than that, we have to send them to CCU. Typically, that does not happen. The MD's will try another medication instead. My personal fave: Digoxin. We have monitor techs that monitor the pt's HR/rhythm and advise us of any notable changes. We monitor VS typically q2H or if we ever need to increase the gtt.

On my PCU floor, we take set gtts and titratable gtts for rhythm and rate control. If titration is needed for BP though, they go to one of the units.

hi all! i am a new LPN, 2 months out of school working in a nursing home. i have a question about taking cardizem PO in geriatric patient w/ chronic a-fib
a few nurses where i work think i am holding cardizem too frequently.
currently i am holding it for a b/p lower than 130/70
what is everyone's take on this?

I found this on the Web:
http://www.drugs.com/ppa/diltiazem-hydrochloride.html

Since there are differing opinions, you may want to request BP and HR parameters from the pt's MD.
Then it's not a matter of each nurse's opinion as to whether or not to hold the medication, it will be according to the MD orders.

IMHO, 130/70 is not hypotension.
However, I would still advise you to seek MD written clarification of when to hold this medication.

thanks so much! tomorrow i am gonna make a list of all my patients on heart meds and since all of my patient are on 1 of 2 doctors it won't take me but 15min to get all the orders.

I agree with the nurses where you work.

Hello-I work on a ortho/PCU post surgical floor. I am ACLS certified as required. Our nurses are offen required to float to ICU where we are given 1-2 of the least critical pts. The other night I floated and was told I would be getting an admission from ED. Pt. being admitted for CVA,Resp failure and rapid a-fib. She was to be on BIPAP and a cardizem drip to be titrated. I was not comfortable taking this pt. We do not have BIPAP on my floor if it is being used for rescue breathing. Also I have zero experience with titrating drips (we also do not take these pts). The charge RN understood my concern and gave me her one pt. who was basically stable. I had a RT comment to me that the pt was a DNR so I could not hurt her and why did I not want to learn new skills? I was totally amazed by the RT comment. I always want to learn new skills, BUT.....1) I do not believe I am even allowed to take a titrated drip (will clarify this tonight) 2) I am not an ICU nurse-would not this pt. be better off with an experienced ICU nurse? 3)I believe this pt. was beyond my scope of practice and accepting her would be both morally and legally wrong 4) When did it become acceptable to practice nursing skills on a pt because they are a DNR?
Your feedback would be appreciated.