titrating cardizem

Specialties Cardiac

Published

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, they are to be transferred to CCU or ICU. Thanks in advance.

We are talking apples and oranges. I am sure every hospital has their own policies about what ICU nurses and floor nurses can do. However, in the grand scheme of things it is our own states Board of Nursing the ultimately that determines the scope of practice and at that level there is no difference between the two (same license, same test, same pay, same job) We all are created equal it is our experiences that make us different and many nurses hide behind their fears and are afraid to make new experiences for themselves to learn new skills, new techniques that makes them better nurses.

I can see both sides of this. I worked tele, stepdown but did have to float to ICU occasionally. As stated above, i would also get uncomplicated patients. I do feel we need to be open to new learning experiecnes. No problem in that if we were not in such a liability oriented world today. No matter how you slice it, once you have accepted report, you are working under your own license and have basically agreed that you have the expertise to handle it. I understand that ICU nurses are still nurses, but the experience they have in their particular area does make a great deal of difference. I do think critical care nurses deserve better pay for what they do. Too bad there arent more opportunities for learning and more extensive training. I know I would have welcomed it and been open to vent pts with lines etc. Its how we gain competency in new areas of care. But then.....old liability rears its ugly head!!

Specializes in Cardiac/Med Surg.

Reading the above post, I guess the difference is that in my hospital you would NEVER have to float to ICU if you didn't work in ICU..as soon as a friend of mine transferred to HSU (heart surgical unit), when necessary she floated to ICU and if it was during her 6 month preceptorship she floated with her preceptor..never alone..so my hospital always made sure you had the experience to go with where you floated to...I wouldn't be comfortable floating to ICU if I didn't have the experience either..I had a 6 month preceptorship for my IMCU floor and did float to ICU once with my preceptor so I would be able to have a patient on a vent...diffentely seeing both sides to this..

As 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.

We 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.

Specializes in ER, progressive care.

If a doc is ordering a cardizem gtt, get some parameters for BP and HR. Typically, once the HR is 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...

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