Max on Levophed? - page 6

Hi! I'm a fairly new ICU RN and recently had a doctor tell me there is no max on Levophed. Our hospital policy states that the recommended max is 40mcg/min. The doctor refused to give me a second pressor because he said that... Read More

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    It is basic physiology not a theory.

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    Our pumps warn us at 100. Hard limit is 150. I've been told I can go as high as 200 but the pump wound't let me. So...150 it is. These are the people who are profoundly septic/bleeding out/actively dying. the last one I had was on the levo, vaso at 0.04, epi at 20 which is our pumps hard max, all to get a MAP around 63. Ended up in SVT so bye bye epi! Also ended up dying, obviously.
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    Our hospital policy has us max levo at 1mcg/kg/min - which is obviously silly. Epi is supposed to max at .15 mcg/kg/min but we can go as far above that as we need to go. It doesn't make any sense to have a max for a catecholamine. But we do what we're told. Whatever. So we'll have vaso at .04, levo and neo "maxed" and just keep going up on epi until their fingers fall off. A few weeks ago I had a patient on a rotaprone bed, CVVHD, oscillator vent, inhaled nitric oxide, IABP and maxed on all pressors. Her fingers and toes were black, shriveled and hard. So sad. And gross.
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    Learned yesterday that max on Neo, per our pumps, is 300 mcg/min.

    That patient was fine until we decided to put the chest tube in the empyema... By fine of course, I mean on 120 levo, 120 neo, 100% FiO2, 20 PEEP, sats 92%, PaO2 48, HR 137. You know...fine!! Cytokine release kills!
    Altra likes this.

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