Re: Lasix gtts

No protocol. If the MD writes lasix gtt then I say, "how often do you want the BMPs?"

In the ICU, the vitals are continuous and the UO is every hour anyway.
I wouldn't feel good about a lasix gtt being on the floor though...

Re: Lasix gtts

Originally Posted by CVRN11

Sounds dangerous to be giving potassium supplements Q4 or Q6 hours.... unless you're checking potassium levels prior to each supplement dose. Sure, the lasix drip (assuming it is increasing urine output) will lower your potassium level, but too much supplementation will cause hyperkalemia... much more difficult to treat than hypokalemia.

Yes, too much K will cause hyperkalemia.... I never give a K replacement without checking labs first and using solid judgement. Maybe I should have clarified by saying its 10 meq every 6 hours PO.... nothing crazy like 40 meq every 6, that would be a lot.

Re: Lasix gtts

On our unit we monitor BPs hourly for a Lasix gtt. Anyone's hospital using Aquaphoresis? (hope I spelled that right) We just started using it. Works somewhat like dialysis. Does the same job for CHF-ers without the kidney damage.

Re: Lasix gtts

If you are in an ICU, aren't you doing q1hr VS and strict I&O any way? Not to mention mo itoring all labs q24hrs, and replacing electrolytes as needed? I don't think any thing else is necessary other than looking at each PTA clinical picture and tweaking is as needed. Seems like common sense?

Re: Lasix gtts

helloo....thers no real protocol for lasix actually...we are doing such monitoring of I&O,V/S hourly in ICU by theway..and electrolytes as per MD orders.

Re: Lasix gtts

I think you thinking is online with patient safety, which should be your priority in any situation. My Nephrologist told me that the usual dose for lasix (his standard) is decided by the pt's Cr times their age. That is for a large dose IVP or IVPB times one or serial times 4. At the point of needing a Lasix gtt, I would agree with some of the other replys, in that, kidney function has declined significantly. However, there is no way to assure that you pt will not respond to the Lasix gtt. That is why I would ensure that the foley drainage bag has a graduated chanber on it. Also, my Nephrologist recommends to titrate any diuretic gtt to achieve no more than 150cc urine output an hour. This would have to be ordered of course. But let's think logically about this. 5 times the normal urine output can't be "normal" or "okay" for anyone. Plus what is pt's cardiovascular staus looking like? Normal urine output for adult is 30cc/hr and if the pt, even if they have horrible kidney functions, can produce massive amounts of urine. Some patients are even prone to Diabetes Insipidus and need to be watched even closer. So my suggestion is question the MD on what paremeters he would like for the K and urine output. Also, I am sure your pt was on Tele but that is a must when playing with fluid/electrolyte balance, so if it's not ordered ask him/her that as well.

From experience, I saw a nurse run a Lasix gtt in without monitoring the pt's urine output for a period over 8hours. Let's just say that the pt produced 10,000cc of fluid in a 12hr shift, the tech failed to mention that till end of shift, and a K of 2.5 kept the next nurse busy for a while.

Good luck

Re: Lasix gtts

It is a nursing measure to take a patient's b/p as the RN deems necessary, you don't need an order, I assume you are on a monitored unit, watch for ectopy. frequent assessment of neuro status. observe the amt of u/o. common sense over-rides policy. these are all things you as a RN can do with out the intervention of a policy or a doctor

Re: Lasix gtts

Hello
Well not to "split hairs", ....Well I guess I am...Urine output is now calculated based on weight. So that old 30 ml/hour or 40 ml/hour or even 15ml/hour is no longer used....Ideal hourly urine output should be no less than 0.5ml/kg/hour
Just my
athena

Re: Lasix gtts

Originally Posted by athena55

Hello
Well not to "split hairs", ....Well I guess I am...Urine output is now calculated based on weight. So that old 30 ml/hour or 40 ml/hour or even 15ml/hour is no longer used....Ideal hourly urine output should be no less than 0.5ml/kg/hour
Just my
athena

You beat me to it!
I always cringe when I see someone say "30mL/hr". I find some docs that still think this too...

Re: Lasix gtts

Originally Posted by athena55

Hello
Well not to "split hairs", ....Well I guess I am...Urine output is now calculated based on weight. So that old 30 ml/hour or 40 ml/hour or even 15ml/hour is no longer used....Ideal hourly urine output should be no less than 0.5ml/kg/hour
Just my
athena

Really? I haven't heard of that, but it makes sense...do you have any more info that I could take back to the ICU?? Thanks!!