[adean]

Is there an amount that Diprivan can only be given up to? There was a PT in ICu and she was on 50cc/hr, she was fully awake! I thought this was alot and she should have been comfortable.

Thanks April

[JennieJenRN]

I have given a lot more than that. Was she on anything else fentanyl, versed. We usually used it in combination with other drugs. You have to look at your policy at your hospital to find out if there is a max dose.

[whirlwind]

in the unit where i am at present, we usually give diprivan till 20cc/hr(that is 200mg/hr), and the patient is already deeply sedated, but there are times when we give till 25cc/hr(esp. male pts with body wt of 100-120kg). but with this dosage pts are going into resp depression and usually having hypotension.
50cc/hr i think is too much... but as you've stated, the pt is still awake..maybe the system is already immune with sedative drugs....

[suzanne4]

Remember that Diprivan does not do anything for pain, an agent for that must be given with the Diprivan. To have a patient on Diprivan drip that is not on any other type of sedation is cruel. If they are on Diprivan drip, they are on a vent, and they need to be kept comfortable. Diprivan does not do that, and that is not what it is used for.

And yes, I have used 50 ml/hr of Diprivan, but it was in a patient that was also getting Morphine, and another agent as well. Dose is also dependent on size and should be titrated to patient's weight as well. Not just the ml per hour.

[CVICURN2003]

Originally Posted by adean

Is there an amount that Diprivan can only be given up to? There was a PT in ICu and she was on 50cc/hr, she was fully awake! I thought this was alot and she should have been comfortable.

Thanks April

Diprovan does not give pain relief. We always give pain meds in conjuction with propofol. Maybe the patient was in pain and that is why she was wide awake? Was it going into a central line? Was the peripheral infiltrated (ouch!!)? The patient should have been intubated to protect their airway, our policy is not to give it to extubated patients. Every once in a great while we cardiovert someone and use diprovan and morphine but we always have an ambu bag and possibly anethesia at bedside to intubate if needed. We (RN's) don't give dipovan IV push the MD does it or the CRNA. Usually in a vented patienet, we sedate to a rass score of -2 or -3. You also have to keep into consideration the other meds the patient is takng at home and the hospital. In my experience patietns will become more tolerant to it and require larger does as days go by. Hopefully, Propofol is a short term med and we can get it off and the patient extubated (in a perfect world) before thier urine becoves "diprovan green". We have given bigger does than that to big men and they will still follow commands (and buck the vent and pull against their restraints)

[CRNI-ICU20]

did you check the patency of your IV site???
how big was your patient? usually, this drug is calculated per kg of body weight.
male or female?
some patients with muscle mass vs. fat mass are easier to sedate.
Our sedation protocols can go as high as 75mcg/kg.....although we have gone higher depending on the patient diagnosis, and response to sedation...if the goal is a SAS of 4....then sometimes it requires that much to sedate and ventilate....

[CRNI-ICU20]

DIPRIVAN Injectable Emulsion should be individualized according to the patient's condition and response, blood lipid profile, and vital signs. (See PRECAUTIONS - ICU sedation) For intubated, mechanically ventilated adult patients, Intensive Care Unit (ICU) sedation should be initiated slowly with a continuous infusion in order to titrate to desired clinical effect and minimize hypotension. When indicated, initiation of sedation should begin at 5 µg/kg/min (0.3 mg/kg/h). The infusion rate should be increased by increments of 5 to 10 µg/kg/min (0.3 to 0.6 mg/kg/h) until the desired level of sedation is achieved. A minimum period of 5 minutes between adjustments should be allowed for onset of peak drug effect. Most adult patients require maintenance rates of 5 to 50 µg/kg/min (0.3 to 3 mg/kg/h) or higher. Dosages of DIPRIVAN Injectable Emulsion should be reduced in patients who have received large dosages of narcotics. Conversely, the DIPRIVAN Injectable Emulsion dosage requirement may be reduced by adequate management of pain with analgesic agents. As with other sedative medications, there is interpatient variability in dosage requirements, and these requirements may change with time

http://www.rxlist.com/cgi/generic/propof_ids.htm

here's a little info, hope it helps

[blueheaven]

I've seen HUMONGUOUS doses of diprivan given, and we titrated it up along with other agents to achieve adequate sedation. WE monitored lab work, etc to make sure we weren't causing any problems with his liver. One thing I have noticed is that you have to go up on the dosage after the pt has been on it for a while. We call it "Milk of Amnesia"

[Ariesbsn]

It really depends on the person you are trying to sedate. I had a pt who, after being given 4 intubation doses of diprivan, was still alert enough to realize that the wrist restraints were thwarting her attempts at self extubation. Midway through the 5th intubation dose, she rolled up onto her shoulders and tried to extubate herself with her feet. I was so not expecting it, that it almost worked.

She was a fresh post-op, and I had just gotten the orders for sedation when she suddenly woke up. Through the whole thing, her systolic b/p never dropped below 130, and her respiratory rate was in the 30s. She was allowed a whopping 2 mg of morphine every 4 hours for pain (this is after 3 calls to the doc). Once I got her sedated, I was running the diprivan in at 77 mcg/kg.

The last couple of vented patients that I got from ER came up trying to climb off the cart after being given enough succs to knock over a horse. The IV used not only flushed freely, but you could draw as much blood as you wanted out of it.

As long as the doctor is OK with the dose you are using, the pt has a blood pressure, and their liver panel is OK, you can worry a little less.

[suzanne4]

Originally Posted by Ariesbsn

It really depends on the person you are trying to sedate. I had a pt who, after being given 4 intubation doses of diprivan, was still alert enough to realize that the wrist restraints were thwarting her attempts at self extubation. Midway through the 5th intubation dose, she rolled up onto her shoulders and tried to extubate herself with her feet. I was so not expecting it, that it almost worked.

She was a fresh post-op, and I had just gotten the orders for sedation when she suddenly woke up. Through the whole thing, her systolic b/p never dropped below 130, and her respiratory rate was in the 30s. She was allowed a whopping 2 mg of morphine every 4 hours for pain (this is after 3 calls to the doc). Once I got her sedated, I was running the diprivan in at 77 mcg/kg.

The last couple of vented patients that I got from ER came up trying to climb off the cart after being given enough succs to knock over a horse. The IV used not only flushed freely, but you could draw as much blood as you wanted out of it.

As long as the doctor is OK with the dose you are using, the pt has a blood pressure, and their liver panel is OK, you can worry a little less.

Sorry, but those physicians need to take a medication course, or be updated by your clinical pharmacist as to how to use Diprivan. Giving a patient only 2 mg of Morphine every four hours IV after a surgical procedure and they are intubated? Shame on them and hope that someone orders that for them, if and when they needed it. The half-life of Morphine when given IV is less than the four hours, it is usually given every two hours when intubated for sedation, let along pain relief after a surgical procedure.