[TGreen]

Our Hospital just purchased a 64 CT machine and DI nurses will be responsible for administering Iv medications to decrease HR during the procedure. Does anyone have guidelines that they have been following to do this safely? Standing orders etc. Guidelines for D/C? I would appriciate any feedback to help develop policy and procedures. The cardiologist are new to this also and have not been very helpful. The Radiologist usually look to us for guidance concerning meds etc. and the only education being done so far is for the techs to run the machine.

[dianah]

Did you do any internet searches? I'm personally not involved but I work with the two cards who do these. I'll try to find out what parameters they use for determining dosage of the Metoprolol they use, d/c etc.

[dianah]

I spoke with one of the Cards today. He "says" there isn't a lot of literature r/t obtaining chemically-induced bradycardia sufficient for the CTA. However, this is what he told me he does:

"I give a 5mg Metoprolol bolus (5mg and then chase it with NS) every 3-5 minutes, depending on the pt's response. By the time I give the 5mg, chase it, break open another 5mg vial and load it into the syringe and get a BP and HR, about 3 min have passed.
Ideally, HR in the 50's gives great images. I'm happy, though, if the HR ends up in the low 60's.
If the BP starts to drop, or hovers in the high 90's with the Metoprolol, I stop giving it and proceed with the scan at whatever the heart rate is at that time.
If I give 20mg and there is NO change whatsoever in the HR (say, baseline is 115 and after 20mg it's in the 90's), I don't give any more Metoprolol and we just scan the patient. (Cleveland Clinic's limit is 600 mg of Metoprolol, but I don't go that high)."
He doses out-patients and in-patients the same. He didn't indicate there was any recovery time (I looked up Metoprolol in Epocrates: half-life=3-7hr. I would touch base with Pharmacy, if your Cardiologists aren't really helpful, as to contraindications [absolute and relative] to Metoprolol administration in this manner); he has no nurse helping him; he screens the pts, arranges the CTA, goes down to CT to administer the dose and observe the scan, then re-formats the scan later.
Hope this helps. Perhaps you could find out from the CT vendor the names of some hospitals that have been using it for CTA, and then contact the involved depts (techs and nurses) for their protocols/suggestions.
Good luck!

[TGreen]

I would feel much better if the HR required was 50 as it is with your card we had heard that the preferred rate was 32 and this had us a little nervous due to the fact that our 64 machine is across the street from the hospital in the MOP building. If a pt were to code we have a code cart but then you must call 911. This seems silly but it is hospital policy. One of the most frustrating things with Radiology nursing for me is that the Director of Radiology is a technologist and has no idea when it comes to nursing and what is considered safe practice. Prior to three years ago there were no nurses in DI and the techs were performing nursing skills and there was no charting. Things are much better now and we have worked very hard to create policies and procedures and documentation to protect ourselves. But as in this instance when something new comes along it is up to us to present new nursing policies. thanks fo your input.

[dianah]

You're very welcome. Another suggestion is to try ARNA (American Radiological Nurses Association); they may have some literature in their core curriculum, or have some official guidelines pertaining to this.

It sounds like you're doing a great job standardizing P & P, documenting and helping TPTB realize the niche you've created is IMPORTANT, and good for PATIENT SAFETY!! Good luck!

[sunnymqt]

We have been doing these cardiac CTA for about a year now on the 16slice CT. The doctor usually prescriobes Toprol 50 mg to be taken a hs and exam scheduled in am. If needed we give Lopressor 5mg IV up to 3 doses. We prefer the HR in the low 60's or lower.
For D/C if the patient is able to tolerate the bp and lower pulse we D?C immediately. We may offer juice and keep them for a little while. We do ask them to bring a driver.

[Lanurse0417]

We have been doing the cardiac CTs for about 3-4 months now and I am also fairly new to the protocols. We have the patient come in the day before for a preassessment and check all their vital signs as well as their medical history and medicines. According to their resting HR we give them PO Lopressor to take home with them. Usually 50-100mg unless their HR is already at the desired rate 50-65bpm. If they are asthmatic (beta blocker contraindicated) we give them Verapamil 240mg when they get here the next day and monitor them for an hour before the exam. They take the Lopressor an hour before their scheduled exam. When they arrived we check their HR and BP and if HR not below 65 then we usually give another 50-100mg of Lopressor depending on current vital and body mass index. They are then monitored for another hour. If after that hour their HR is desireable then we can scan them if not and vitals are still stable we will sometimes administer Lopressor IV 5mg every 5 min X 3 doses or until HR is at desired rate. Usually we dont resort to the last, usually the first home dose is enough and the rest is not needed but we have used it a few times. We usually do not give more then 200-250mg PO or 15mg IV all total.

[DutchgirlRN]

The patient is monitored, VS, 02 sat, EKG.
A strip is obtained and put on a flow sheet prior to pushing any Lopressor, if PR interval is greater than .24 we don't push any Lopressor.
The patient is intially given 15mg of Lopressor IVP over 5 minutes. VS are monitored Q 3 minutes and written on the flow sheet. If the Systolic goes below 100 we stop. We wait 15 minutes. If the HR does not reach 60 bpm we give an additional 35mg Lopressor IVP over 8 minutes. The CTA is then done regardless of the HR.
Inpatients or ER patients are returned to their unit. Outpatients must stay and be monitored for an hour following the CTA. The total amount of Lopressor given is added to the flow sheet and if going back to a unit the amount of Lopressor given is reported to the patients nurse.