New to CVSICU...cardiac gtts - Page 2

Ithink we need to remember that every hospital, unit, physician, location in the country....all have their own feelings about which drip to use when. It is really patient, facility, and physician preference as to what to titrate and when.

Check your facilities policy and procedure manual. Know you units specific standard of care. There should be a drug book policy on your unit or computer.

The actual titration is based on patient response. You start at small increments and increase more or less rapidly depending on the patient vitals and response. What one patient may not be responding to and will need titration at 5 or 6 mcgs at a time....another patient will have rebound tachycardia and HTN with as little as 1-2 mcg.

It comes in time and experience....I know when I started out in ICCU I depended ALOT on the senior nurses (10+y) to show me the tricks of the trade...it's a shame that learning model is no longer used and the older nurses are no longer considered valuable.

Here is a good rule of thumb....http://workplacenurses.com/id69.html you might also find this site helpful...icufaqs.org

Thanks for the site!

Absolutely! Identify nurses you can use as resources on your unit. They are your best friend! It is a shame we value educational attainment and certifications over experience. Nothing beats experience!

OP, Make a list of the drugs you see most frequently used and then basically memorize its mechanism of action, what effect it will have on your patient, what your facilities acceptable dose range is, potential adverse effects, etc. It also really helped me to know what receptors were involved.

Titration comes with time and experience and depends on patient's response. Each nurse develops their own way of doing things. My preceptor told me I should always titrate by twos, some told me by fives, etc. I try to look at my patient's response to guide me. For instance if I am on Levo for hypotension I am going to be much more aggressive if my BP is 60/30 as opposed to 85/45.

This site may help....it says for students but it is a great site.......DosageHelp.com - Helping Nursing Students Learn Dosage Calculations

YOu might also want to get a weight based pocket reference
CRITICAL CARE INTRAVENOUS MEDICATIONS CHART
IV Critical Care Infusion Drip Chart
Appendix D - Drug Calculations Sheet

Calculations

In our ICU/CVU we have our specific hospital policy and protocols (thank you State of CT for your constant visits and citations) for EACH and every titratable gtt (begin infusion at .... titrate by .... max infusion rates, etc...) Each room has it's own protocol sheets/book in the room.

I just recently started in a CVICU as well.. I am nervous as to drips as well.. Ive worked in a Busy Emergency room, so its not like I havent see many of these drips, but titrating 5-6 at a time is quite different!

When the patients come out from surgery, they already come to me with most everything hanging... Is almost everything compatible? It seems that no matter what drugs they are on, they are always running through the same cordis... and whenever I need to hang a new med, Im doing IV interactions with ALL the drugs running through that line... it seems a little tedious... anyone have any info to shed on this?

In my ICU we usually have triple leumen central Lines with multiple manifolds. I usually designate one specific one to just IV fluids (keep it on the same side as my CO stuff) and keep my drug manifolds on the other side. I also label ALL my meds!! I like to separate drugs as much as possible even if compatible so I can turn off or turn up the rate on something as soon as I need to.

Separating compatible drugs is a wonderful suggestion, and I always try to do this. You never know when you may need to run your IVF in quickly, and you don't want to risk bolusing several drips in the process!

To AMAC8487: "everything is compatible in the world of anesthesia"...sorry, that's my little joke! But you will find that it seems true! Although it may vary at your facility, generally, all the pressors are compatible together and can all go with propofol. Dilators go together usually. Insulin, fentanyl, propofol ok. Amiodarone and bicarbonate compatible with very little so best to run separate! We have an idiot sheet for drips, but hearts are managed differently. Hearts have a bunch of lines and ports; trauma surgeries have a 1 port cordis...so yes I do understand. Hope this helps!