[kabarnes]

I have a question about giving a NTG bolus. I was asked to give a patient a 12.5 mcg bolus of NTG and then start the drip. I was unsure of how to do that. I read in my IV drug book that the AHA guidelines for Unstable Angina/MI to give 12.5-25 mcg bolus of NTG and start a drip at 10- 20 mcg/min. It does not specify exactly how fast to give the bolus. I was reluctant to give a bolus given that I have always just started a drip at 5-10mcg and titrated the drip to effect. The patient was having unstable angina and was not actively infarcting, he had been given a SL spray of NTG, MSO4 2mg and Ativan 1 mg witha resolution of symptoms. I told the physician that I was not comfortable giving him a bolus because I didn't have proper guidelines, and that I would start the drip at 10 mcg/min and titrate accordingly. He accepted this, but was curious as to why I would not give the bolus. Any insight in this issue would be greatly appreciated.

[micro]

would clarify specifically with doc
use pharmacy as resource
use fellow more experienced nurses

[hoolahan]

WOW! I have never given NTG as a bolus. They are really doing things differently since I went into HH. I have seen NTG boluses given accidentally (Like when a drip was D/C'd and a new nurse flushed the line) and watched BP plummet rapidly, so I personally am with you, I would be uncomfortable with the idea.