Will someone please explain

Specialties CCU

Published

Why do some facilities run levophed as a weight based rug in ADULTS? I cannot find any pharm book that supports this. As far as I can see, this is a med error.

Please enlighten me.

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It wouldn't be a med error if the hospital policy provides that it is acceptable to run norepi in mcg/kg/min.

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Specializes in multispecialty ICU, SICU including CV.

My facility doesn't run it like that, it is ran in mcgs/min. However, it's not a med error if it is ordered to be ran in mcg/kg/min. Probably somewhere way back when they first started using Levophed weight based dosing was not tested, so it might not be evidence based, but it's not "wrong", persay. There are lots of drugs that are prescribed "off-label." I would think this falls into that category. If this was my patient, I would bring it to the MDs attention that this wasn't generally the standard, but if he really wanted it that way, I would do it.

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Specializes in CVICU.

I like running drips in mcg/kg/min. 30 mcg/min of Levophed isn't going to affect the 120 kg guy down the hall as much as it affects my 65 kg lady. Makes sense to me!

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Specializes in ICU, ER, EP,.

Our cardiac surgery and cardiac ICU run weight based drugs, including NTG to be as precise as possible. Our policies protect us.

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Specializes in CVICU.
Our cardiac surgery and cardiac ICU run weight based drugs, including NTG to be as precise as possible. Our policies protect us.

I like running nitro in mcg/kg/min... especially knowing that arteries aren't dilated until after doses reach 1 mcg/kg/min. I keep trying to get my hospital to do this, but I'm not having much luck :(

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Specializes in multispecialty ICU, SICU including CV.
I like running nitro in mcg/kg/min... especially knowing that arteries aren't dilated until after doses reach 1 mcg/kg/min. I keep trying to get my hospital to do this, but I'm not having much luck :(

Many cardiac surgeons run nitro in mcg/kg/min (everywhere I have worked, they do.) I'm not sure where you are getting your data as far as arteries not being dilated until 1 mcg/kg/min though. I have never heard or experienced this. I have started NTG at .5 mcg/kg/min and dumped patient's B/Ps, so if that's not dilated out, I'm not sure what is.

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Specializes in CVICU.
Many cardiac surgeons run nitro in mcg/kg/min (everywhere I have worked, they do.) I'm not sure where you are getting your data as far as arteries not being dilated until 1 mcg/kg/min though. I have never heard or experienced this. I have started NTG at .5 mcg/kg/min and dumped patient's B/Ps, so if that's not dilated out, I'm not sure what is.

I heard this at a CCRN review... upon further review, it appears that this info is old: http://www.jstor.org/pss/3463066

I just looked in my book from the CCRN review, "Critical Care Pharmacology" (2009) by Robin Donahoe Dennison. It says nitro causes arterial dilation in doses greater than 1 mcg/kg/min. However, I can't find any recent evidence to support this. This is exactly why nothing should be taken at face value :)

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Very insightful responses. Thank you everyone!:)

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