by caringchic

So i work on an CCU/ICU sometimes a step down unit, depending on how bed control is allotting bed space. Anyways.. I had an order to hang a lasix gtt and when I asked if the unit had any protocols or policies r/t Lasix gtt. I got a look of bewilderment from my fellow nurses. I was expecting something like monitor BP q 30min x 3, w/ UO q 1hr, w/ KCL replacment at least q 24hr. Or a KCL rider, but no one seemed to be aware of any such thing.. so I just used nsg judgement and did that anyways. Does your unit have such parameters?

Re: Lasix gtts

I've never seen such parameters on our unit; we're a tele floor, 4:1 ratio, Q4hour vitals, monitor u/o depending on pt disease process; with a Lasix gtt I'd monitor Q4hours, there aren't any hard/fast rules on that. Oh, and daily weight with all ppl on lasix gtts. Other than that, just hope they have a foley!!!

Re: Lasix gtts

I forgot to add that I've seen pts taking PO KCL like Q4 or Q6 and monitor labs. For some reason I can't edit the original reply.

Re: Lasix gtts

Our policy is just an exact copy of the typical IV med book, I think they would be in for copyright infringement, if it weren't common knowledge. What you did sounds like good clinical practice. I feel like adding some tweaks, but those really depend on your patients total picture. Evidence and clinical judgment always override policy in any event. Good job. I'm sure both you any your patient are breathing easier.

Re: Lasix gtts

No real protocols for lasix gtt for us... but always good idea to check renal at least q12, and definitely monitor BP q30-60min for a couple hours after starting or titrating gtt. Occassiionally I've seen lasix titration to maintain a certain UO per hour - but usu. MD-driven

Re: Lasix gtts

By the time a patient goes on a Lasix drip thier kidneys are so shot I can't imaging replacing K+. More often or not they are hyprekalemic. I guess in ICU I expect VS to be checked at least Qhr anyway, close monitoring of I/O comes with ICU as well. I guess what I'm saying is everything I would do for a patient on a Lasix drip I would do for a patient not on a lasix drip but in ICU for any reason. On a floor?... there, we don't use Lasix drips.

Re: Lasix gtts

Lately we've been using more lasix/diuril gtts than just straight lasix gtts.

Re: Lasix gtts

we often see pt's K drop when given lasix gtt ~ it is usu necessary to replace K (from my experience)

Re: Lasix gtts

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.

Re: Lasix gtts

If a patient is being admitted under our CHF order set then they get q6 basics and potassium replacement protocol. Any other patient who is placed on a Lasix drip is left up to the MDs discretion for checking labs and K replacement. If I'm the one to start the drip I do check vitals more frequently for the first couple of hours and obviously pay attention to the urine output, but we have no solid protocol for initiating the drip.

Tom