- by A_Simp Aug 7, '10I just started working on a progressive care unit and want to know if anyone has a good link, resource, study guide or cheat sheet on drips - cardizem, amiodrione, heparin, etc? I ultimately would love an Excel spreadsheet with all the info on it so I could keep it with me at work. If not, I'll eventually make my own.
I've tried to search through my hospital policies but have not be able to find any guidence for titration, VS frequency, etc.
Thanks for your help! I'm sure I'll get a lot of great tips!
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- Aug 7, '10 by aCRNAhopefulYou'll have to be more specific about what you would want on this spreadsheet. It could end up being a pretty lengthy document. Just find a good drug reference that sums up what you need to know about a certain gtt, and review it before your shift starts. You'll have it down before too long.
- Aug 8, '10 by luckyouThe info will vary from instituation to institution and the doseages will also vary depending on how your unit runs drips (mcg/kg/min or mcg/min) here are ranges for some common gtts off the top of my head on my unit
Epinepherine 0.01-0.1 mcg/kg/min
Norepinepherine 0.01-0.2 mcg/kg/min
Vasopressin 0.01-0.04 units/min
Phenylepherine 0.01-1.0 mcg/kg/min
Milrinone 0.25-0.75 mcg/kg/min
Dobutamine 1-20 mcg/kg/min
Dopamine 0.5-20 mcg/kg/min
Esmolol 50-300 mcg/kg/min
Diltiazem 5-15 mcg/kg/min
Nitroglycerine 0.5-5 mcg/kg/min
Nitroprusside 0.5-5 mcg/kg/min
Amiodarone 150mg bolus followed by 1 mcg/min for 6hrs then .5 mcg/min
cisatracurium sp? 0.03-0.1 mcg/kg/min
Heparin usually has a nomogram or at my discretion while I'm running ECMO
Fentanyl 25-effect mcg/hr
Ativan .5-effect mg/hr
Propofol 5-100 mcg/kg/hr
Insulin 1-?? units/hr
There are more but the ones I've listed will probably cover you close to 90% of the time. Again each institution will be different. Also more important than doseages is knowing what the drugs actually do physiologically and how to titrate them in conjunction with one another. This takes experience but if you know how the drugs are actually acting on your Pt. it will be easier for you.
- Aug 8, '10 by A_SimpThanks for the posts. Any info on titration would be helpful too. As an example, we had a pt on cardizem 10mg/hr and my preceptor changed it to 5mg/hr then off. I realized some drips you only titrated 1-2 mg or mcg at a time and then need to monitor VS q15min, etc. Any guidence or generalized parameters would be great.
- Aug 8, '10 by General E. Speaking, RNSorry, I am not going to be much help. I have a hand-me-down copied paper in spreadsheet form that one of my preceptors gave me. She got it from her last hospital. It has info about initial dose, titrating, max dose, action, side effects, etc of many of the ICU drugs we use. It is very helpful. Sorry, I am too 'old school' and technologically inept to get it physically from my hands to the computer and to you!
I'm going to pay attention and see what kind of response you get. So far, all the drug info on my over-copied paper is current but it would be nice to have another source.
- Aug 8, '10 by A_SimpSounds like what I'm looking for. too bad it's not electronic.
- Aug 12, '10 by stressgalLove my Tarascon Pharmecopeia pocket giude. Small, fits in my pocket and has all the info I need. I also have the Critical Care pocket guide. I must say these are my FAVES, and I do tend to buy lots of reference guides
- Aug 13, '10 by CABGx4Typically, cardizem doesn't need to be titrated. It either works at 5, 10, or 15 but maybe pt needs cardioverted at 15 if not too late. Not sure why but it only goes in 5mcg increments. Amio is not titratable. Heparin follows your hosp's nomogram. Insulin gtt's are more annoying than anything so hopefully you have a line you can draw you CBG's from.
When I worked step-down, we didn't do too much titratables. If you want all that action you better move to ICU baby!!!! You'll get more than you hoped for!!