IV Lopressor...who can administer it?

[HurricaneBreeze]

Last night at work I ran into a predicament that I have now recieved about 6 different answers for. I am an LPN on a busy med/surg unit. We often see patients who are step down from critical care or new admits with stable angina on central telemetry, some with IV Lopressor. Up until just a couple of months ago, anytime the med needed to be given, we would call the Central Telemetry Nurse and she would come push the medication as we are not telemetry nurses, we don't monitor the tele and we aren't even required to be ACLS trained. However, our manager has decided that now we can IVP our cardiac drugs on our own as long as we follow the guidlines in the Emergency Drug Guide located on the crash cart. I am pretty sure that as a non-ACLS LPN that I cannot administer this medication. However, do the RNs that push the med have to be ACLS certified. As per usual, no policy could be found regarding this issue.........

I am interested in feedback from any state or facility. I'm just curious as to what other places policies are. Thanks!!!:heartbeat

[mykrosphere]

i see youre an lpn and i assume you cant do iv push meds anyway?

im only aware of the lpn "rules" in ohio

im an rn and give iv lopressor quite frequently (ltach) but usually the pts im giving it to have bedside monitors.

i am not acls certified yet.

the changes in hr are pretty obvious when youre pushing it, and sometimes even the rhythm depending on the rate in which youre giving it.

your manager sounds kind of off......

i dont know!

[blondy2061h, MSN, RN]

At my hospital, a critical care nurse can push it. Any other RN can put it in a 50ml bad of D5 or NS and run it piggy back over 15 minutes.

[Tait, MSN, RN]

I work on a cardiac/tele floor. I am a non-ACLS certified RN. We push Lopressor/Vasotech/Dij routinely. We call our central monitoring unit and alert them, and they are to call us of any significant changes in heart rhythm.

As with most things nursing, results in your area may vary. :)

Tait

[Duffy v. 2.0]

While beta blockers can sometimes exacerbate or even initiate an AV block, there really isn't anything significant from a telemetry standpoint that needs to be monitored.

Wow. I would hate for you to give me any IV meds. I completely disagree. I would only give this med if they were on a monitor I could see as I gave it, on pulse oximetry, and automated blood pressures. You can't tell from a dynamap if the hr is regular or irregular and it would be hard to check a radial pulse at the same time as administering the med.

[mama_d, BSN, RN]

In our facility, all IVP BP meds require tele. I can't push it myself (LPN scope of practice excludes me from doing pushes in MO), but since someone has to watch the monitor, the RN pushes it and I park myself in front of the monitor (we don't have monitor techs).

We also are supposed to get a baseline BP/HR prior to pushing, then check q5min x 3 after. If it's someone who has been on it routinely, we'll usually just get baseline BP, but still always watch the monitor. Conversely, if their BP was a little soft to begin with, but they have to have the beta-blocker (such as a new positive troponin), I'll monitor BP q5min until stable, even if it takes an hour. There's just too much variety in our patient's comorbidities for me to be comfortable taking the drug book's word on metabolism of the drug for me to be comfortable stopping monitoring after the book says it should have peaked.

I had someone on day shift kill one of my patients the shift after mine by pussing Lopressor 5 mg too fast. So it definitely can and does happen.

[hypocaffeinemia, BSN, RN]

Wow. I would hate for you to give me any IV meds. I completely disagree. I would only give this med if they were on a monitor I could see as I gave it, on pulse oximetry, and automated blood pressures. You can't tell from a dynamap if the hr is regular or irregular and it would be hard to check a radial pulse at the same time as administering the med.

I don't know where you work, but most telemetry systems don't have bedside monitors to watch as you push outside of ER/ICU/stepdown

If you are expecting to stay in constant communication with a monitor tech, I'd wager that takes just as many extra hands as checking a radial pulse does unless you're wearing a headset, and a little known fact most nurses are unaware of is the signal delay of 3-15 seconds between what the patient experiences and when the dysrrhythmia crosses the screen when using telemetry.

Additionally, you can indeed tell from most dynamaps if a heart rate is irregular by setting it to beep out the pulsations from the SpO2 sensor and listening. It's a useful tool.

---

Too many people think telemetry is some panacea monitoring solution when in reality it doesn't hold a candle to basic patient assessment.

[hypocaffeinemia, BSN, RN]

Conversely, if their BP was a little soft to begin with, but they have to have the beta-blocker (such as a new positive troponin),

JCAHO has changed their stance on the administration of beta blockers within the first 24 hours of aMI as it was determined that beta blockers can patients with new onset heart failure into cardiogenic shock due to their negative inotropic activity.

[Virgo_RN, BSN, RN]

I am a non ACLS certified RN working on a cardiac telemetry unit, and I am allowed to push IV metoprolol. When I was an LPN, I was not allowed to administer any vasoactive medications intravenously.

At our facility, metoprolol can be mixed in a minibag of NS and administered IVPB at a specific rate without continuous telemetry monitoring; this is what they do with the post op patients on the med/surg floor (they do not have tele).

However, when given IVP, continuous cardiac monitoring is required. I typically use a dynamap at the bedside and take vitals Q5 minutes, and call the monitor tech to advise me of any changes in rate or rhythm. We also have a portable bedside monitoring unit that I like to use when it's available, but with only one on the floor, it's not always available.

As someone else mentioned, if the Dynamap has pulse oximetry built in, you can use that to monitor pulse. If not, a pulse ox can do the trick. And of course, looking at the patient will tell you a lot about how well they are tolerating the medication.

[Duffy v. 2.0]

I don't know where you work, but most telemetry systems don't have bedside monitors to watch as you push outside of ER/ICU/stepdown

Actually, in my experience, they do. They are generally small mobile units used for transporting pt's to other areas of the hospital. I would either use one of these or be in constant communication with someone watching the monitor while I gave it.

Too many people think telemetry is some panacea monitoring solution when in reality it doesn't hold a candle to basic patient assessment.

I agree that the first rule of monitoring a pt's ekg rhythm is to treat the pt and not the monitor, however if you rely on a pulse oximeter alone to administer cardiac meds you will end up killing a pt someday.

It's listed in any drug guide to monitor ekg, bp, and pulse rate when giving this med. I can just picture an attorney asking you what rhythm the now dead pt was in when you administered this drug. Your answer... Gee, I don't know. My dynamap didn't tell me that.

[rjflyn, ASN, RN]

At my hospital, a critical care nurse can push it. Any other RN can put it in a 50ml bad of D5 or NS and run it piggy back over 15 minutes.

Im just curious how that works when the the standard order is Lopressor 5mg IV repeat x3 q 5 mins.

[RNKPCE]

It is surprising how many tele nurses work where they don't have to be ACLS certfied.

My thought on who can push it isn't as important as who know that patient current history, most recent vitals and who has the knowledge base to monitor after the med is given. In most instances it isn't who physically pushes it that matters but who is there in the 5mins to 2 hours later observing the patient and their rhythm and their vital signs.

I don't believe LVN's can push these meds in California, I know they can't at my hospital nor can RN's unless they are on a monitored floor.