[sharann]

I am having such a difficult time understanding the Nipride drip formula.
Generally we have orders to "titrate for SBP" of whatever value.

So I understand this much: The bottle is 250cc's
I believe the cpncentration is 100mg
I know we dose it by mcg/kg/min(right?)

So how do I set the IV pump(it is a stupid pump not a smart pump)
so I start off with 0.3mcg/kg/min or 0.5mcg
Thanks
I work in PACU and we rarely use this particular drip so I am not well versed in this. The anestheseologist tried to explain it to me but I still am not quite there obviously

[TopherSRN]

Originally Posted by sharann

I am having such a difficult time understanding the Nipride drip formula.
Generally we have orders to "titrate for SBP" of whatever value.

So I understand this much: The bottle is 250cc's
I believe the cpncentration is 100mg
I know we dose it by mcg/kg/min(right?)

So how do I set the IV pump(it is a stupid pump not a smart pump)
so I start off with 0.3mcg/kg/min or 0.5mcg
Thanks
I work in PACU and we rarely use this particular drip so I am not well versed in this. The anestheseologist tried to explain it to me but I still am not quite there obviously

Nipride is usually 50/250, and thus would be calculated the same as single strength NTG.

I really don't understand what the question is. Do you want to know specifically about Nipride dosing or do you not know how to calculate drip rates manually? If its the latter thats something you should have learned in school. Its also very important for someone working in PACU. If you dont have a pump with formularies loaded on it then you just manually calculate the drip rate in mcg/kg/min like every other weight based drug.

for a 70kg pt using 50/250 (200mcg/ml) at .3 mcg/kg/min thats
70*.3=21 mcg/min *60 =1260mcg/hr / 200mcg/ml= 6.3ml/hr

Or you can multiply pt wt (70) X .3 = 21 and that is the ml/hr rate for 1 mcg/kg/min, then just divide by 3.33 (1/3) to get 6.3 ml/hr (ty Dr. Cusick )

There are a million different ways to calculate drip rates. Its basic algebra and should be second nature since you won't always have a pump to do things for you.

[deeDawntee]

Thank God I always have a pump to do this for me because it is so much more efficient!! But if I didn't, I would always have another nurse or the pharmacist double check the dosing with me. Also, there are drip tables in a lot of the ICU pocket guides that you can use to also double check your answer. Do you have access to those? They also step you through the process of calculating the drip rate. They have the pt's weight along the top and the rate along the side... actually the monitors have drip tables built into them as well, come to think of it.

Hope that helps. And you are not a bonehead... take that out of your vocabulary. You didn't get as far in nursing as you are by being anything but bright!! If you see yourself that way, you will learn easier, I promise.

[sharann]

Originally Posted by TopherSRN

Nipride is usually 50/250, and thus would be calculated the same as single strength NTG.

I really don't understand what the question is. Do you want to know specifically about Nipride dosing or do you not know how to calculate drip rates manually? If its the latter thats something you should have learned in school. Its also very important for someone working in PACU. If you dont have a pump with formularies loaded on it then you just manually calculate the drip rate in mcg/kg/min like every other weight based drug.

for a 70kg pt using 50/250 (200mcg/ml) at .3 mcg/kg/min thats
70*.3=21 mcg/min *60 =1260mcg/hr / 200mcg/ml= 6.3ml/hr

Or you can multiply pt wt (70) X .3 = 21 and that is the ml/hr rate for 1 mcg/kg/min, then just divide by 3.33 (1/3) to get 6.3 ml/hr (ty Dr. Cusick )

There are a million different ways to calculate drip rates. Its basic algebra and should be second nature since you won't always have a pump to do things for you.

You know, I asked this question because I DO NOT know how to titrate Nipride. If I knew how to do it I would not have asked this question in a forum(That I believed to be non-judgemental). Too bad that one who answers a question so eloquently can insult me in the same post. Maybe if I hadn't read this after a 15 hour day I wouldn't be so touchy, but you sure mad me feel really lousy topher.
Please do not tell me what I should know in PACU. We RARELY use this drug as it has such a profound and rapid effect on pressure and most of our patients don't have Art lines(because anesthesia chooses not to).
I know alot of thing believe it or not though. I know about NPMR and DPMR's, general anesthtic, all kinds of pain management and about 100 ways to save an airway. What I don't know is drips such as Nipride that have constants and such.
Thank you for the words deeDawn tee. I need to know how to calculate the rate of infusion in Ml/hr so I have to be able to double check by hand don't I ? So I will check with some of our ICU nurses and see if they have some tabes as you suggest.

[TopherSRN]

Originally Posted by sharann

You know, I asked this question because I DO NOT know how to titrate Nipride.

It's typically .5-10 mcg/kg/min, though I usually start at .2-.3 and go up from there. Most of are patients have a-lines, but I've used in patients who don't. Just be conservative, it has a very short half-life which makes it a little more forgiving.

Originally Posted by sharann

I need to know how to calculate the rate of infusion in Ml/hr so I have to be able to double check by hand don't I ? So I will check with some of our ICU nurses and see if they have some tabes as you suggest.

I just explained how to calculate a drip rate using basic algebra. Nipride would be calculated the exact same as any other weight based drug (esmolol, labetalol, levo, epi, dopa, dobutamine, milrinone, inamrinone, NTG, etc, etc). Even if you have a chart, you should still know how to do drug calculations. We had to pass a drug calculations test at the beginning of every semester to even stay in the program.

Sorry you didn't like my answer, but I actually taught you how to do the calcs instead of telling you to go find a chart to think for you. We have pumps with formularies, so I don't do many calcs, but I still know how to do them. I've even caught a few nurses who had incorrectly programmed a pump because I knew the rate didn't correlate with the dosage.

[Tropical Nurse]

Might be a bit off the topic but a really easy way to remember how to calculate mcg/kg/min is to use it.

eg: at our hospital we use dopamine 200 mg in 50ml; if we have a 50kg man, the ml/hr to give 5mcg/kg/min would be:

mcg (5) x kg (50) x min (60) divided by mcg/ml (4000) = 3.75 ml/hr.

Ever since i was shown this by a fellow nurse, I have never balked at the mcg/kg/min calc.

[sharann]

Thank you. I really asked the question because I do not want to depend on any chart. I really want to learn how to do this. Unfortunately people don't generally have the time or inclination to explain things in my area, or they don't know and just wing it(which I find disgraceful).
So, I am fine with the algebra actually, it is the formulas I didn't understand. I learned to do it ratio proportion in school.
Yes you are all correct, our Nipride is 50/250(I told you I wan't that familiar with it!)
Ok, so I will continue to practice with scenarios I find and eventally may become more adept.
Thanks