[DutchgirlRN]

For CTA's we give 15 mg IV over 5 mins, if we don't get a HR around 60, we wait 15 mins and then we give an additional 35 mg IV over 10 minutes. I have been reading that some depts give the Lopressor PO the evening before and the morning of. I would be interested in reading this protocol because I understand it works better. Obviously it is less time consuming as well. Thanks!

[jer_sd]

I have worked in two outpatient clinics that do CTAs.

the original one we had the patient take 50mg of betablocker of choice at night before bed, then another dose 2 hours before the exam. If needed we suppliment with IV on the table.

Current location, patient arrives 60 minutes before schedualed scan time, check HR and BP, administer 50 or 100mg PO repeate in 30-45 minutes if needed. We have never given IV betablockers. This results in much less paperwork and legal issues with dispensing medications.

Now different radiologists prefer different betablockers but I have not observed much difference between them.

Hope this helps.

[KnittingRN7]

I work at an outpatient clinic, not affiliated with a hospital. As I posted before we are only using IV metoprolol because it is faster. The only problem is we only are scheduled 30min per patient, luckily we are not booked solid everyday, so many patients have been there 1hr to 1 1/2 hrs depending on response to drug and IV starts. Unfortunately I job share so there is only 1 of us on a day with 1 or 2 CT techs. I am usually rushed to send a pt out so if their HR and BP are back to normal, which they are in the first 10min or so they go home. I just wonder what happens 40min later when all the metoprolol catches up to them.

We also have an MRI scanner so we have been doing adenosine MRI stress tests on pt's , so we are busy running between patients, or the CT techs do the test without meds.

I have asked for 1 hr appts or 2 nurses scheduled but the Dr's own the clinic so it probably won't happen.

I do like the work though, it is interesting and the technology is amazing. My body is happier not being in the hospital lifting and dealing with MRSA daily.

[LaneDoesCare]

I feel am so pleased that I can add something to your postings. Being a new gal on the block I'm soaking it all up. CT of heart in our unit has recently started being preprepped with toprol 50 mg the night prior and 25 mg 2 hours prior to the exam as someone already discussed. I consult with the ordering physician to verify the patient's tolerance and he writes the prescription. This then places the premedication responsibility on the ordering MD. Thus far I have not needed to administer any further medication other than the Nitroglycerine. The radiologist prefers the heart rate at 60 for the test. By the way, I want to thank you for the assistance you offered me since just getting my feet wet.

[KnittingRN7]

Thank you for your response. I just don't know logistically how we would do that. We would have to call every patient and every pharmacy for them for a script for lopressor. Then when we know their creat call them back for premed if needed. As I posted before we only have 1 nurse a day and can have 9 patients scheduled. We also look up every patient's history,their creat. and a recent EKG before they arrive. There would not be time to call every patient with a prescription. We also take add ons the day before or day of test if possible. Unfortunately we have not been consistently busy enough to justify 2 RNs every day. But that is what is needed. Thanks though because it helps to hear what other facilities are doing, that is the information we need. It feels like each facility ours especially are always trying to reinvent the wheel. I know there are places out there doing it successfully and efficiently. Any other suggestions would be appreciated.