titrating cardizem - page 4
Our TCU floor does not titrated cardizem gtts. What is involved with the titration of a drip. It would be nice if we could and cut down on patient expense. If the cardizem needs to be titrated,... Read More
Jan 19, '09As far as I know it is relatively common practice for tele nurses to float to ICU. I guess its a matter of how comfortable the float nurse feels with the assigned patients. You are fortunuate to work in a facility where it appears they are aware of the possible dangers. Beyond that a float needs to be assertive and not accept pts he/she does not have the skills to care for safely. I was never put in that situation.
Mar 28, '12We have a telemetry assistant and a resource nurse who checks on all patients on telemetry, especially those on any type of hemodynamic drip. The TA keeps a continous eye on the HR and makes notes beside the patients rhythm that they are indeed on a hemodynamic drip. The resource nurse makes sure that the patient is stable, and if unstable, arranges for them to be transferred to a progressive care unit or ICU.
Mar 28, '12If a doc is ordering a cardizem gtt, get some parameters for BP and HR. Typically, once the HR is <60 we are supposed to stop the gtt and call the doctor, but some will not want you to call them unless the HR is <50. Some will not want you to call them unless the SBP <80. Typically, the orders I get are to titrate to keep HR <100 and SBP >100.
You start with a bolus dose of 0.25mg/kg over 2min. If ineffective, give 0.35mg/kg 15 minutes after the initial dose, unless the doctor doesn't order that. I had to start a cardizem gtt on a patient and the doc did not order a bolus, he just wanted me to hang the drip. After you bolus (if ordered), you hang the continuous gtt. It is usually started at 5 or 10mg/hr, then you titrate to effect. It's based on your nursing judgement, really. For example if 5mg/hr isn't really lowering the HR that much and if the BP is still okay (say BP is 130/86) then go ahead and up the dose to 10mg/hr. You have the order. The max dose on my floor used to be 10mg/hr and if we needed to go higher, they would have to go to ICU, but they changed that. We can go to 15mg/hr. I've actually never seen more than 15mg/hr. Infusions of 15mg/hr or more for more than 24 hours is not recommended.
Vitals should be monitored Q15min during initial infusion for at least the first hour, then you can up the monitoring to Q30min and then Q1H once the patient is more stable.
ETA: I just realized this thread is old...