New to CVSICU...cardiac gtts

  1. Hi everyone! I am a new nurse in the CVSICU. Just completed my first week of orientation and wow there's alot to learn!! I was wondering if anyone had any advice on learning the cardiac gtts. Especially in regards to titrating which makes me nervous. Any study tips?

    Thanks for your help!
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  2. 23 Comments

  3. by   Nursingbride12
    I am a new grad who started about 7 months ago on a cardio vascular transplant unit. My advice would be to get to know the drips you use most often and know how long it takes them to work.

    For instance, if you're nervous about titrating Vasopressin, then you could bump up the drip fast because of the low blood pressure. But then your systolic pressure will be in the 200's and will continue to climb.

    So in short my advice is find the drips you use most often, and know how fast they work.
  4. by   Stormy8
    Thanks for your help! I'm trying not to feel too overwhelmed. Going to take it one day at a time but besides the gtts, there is sooooo much to learn! Very excited/nervous.
  5. by   prep8611
    We never titrate vasopressin....
  6. by   limaRN
    We don't titrate vasopressin either. It's either at 0.04 units/ min or off.
  7. by   Nursingbride12
    On. My..
  8. by   Nursingbride12
    Ok my point is still the same.

    And on my unit we can titrate Vasopressin from .03 to 3.
  9. by   prep8611
    Quote from Nursingbride12
    Ok my point is still the same.

    And on my unit we can titrate Vasopressin from .03 to 3.
    3? How is that possible? Y not use a different pressor?
  10. by   dah doh
    Titrating gtts comes with experience. It helps to learn the range for each gtt. Based on the drug range, it gives you an idea how to titrate. So if the range is small like 0-20, change the gtt by small increments, but if the range is larger like 0-300, then you might want to change the gtt by larger increments. It is also based on your facility's policy, but mostly based on patient's response to the change in drug dose. FYI: Vasopressin 0.1-0.4 for bp and max of 2 for bleeding at our facility.
    Last edit by dah doh on Feb 11, '13
  11. by   Nursingbride12
    Quote from prep8611

    3? How is that possible? Y not use a different pressor?
    I personally have never gone up that high. If we were up that high Im sure the pt would be on plenty other drips.

    Really I was just using this as an example of titrating....
  12. by   Esme12
    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
  13. by   Nursingbride12
    Thanks for the site!
  14. by   Sugarcoma
    Quote from Esme12
    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.
    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.

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