IV Push Lopressor on a Med-Surg Unit??

[LuvMedSurgNsg]

Can anyone give me some input on this one? Some of our surgery guys want us to administer IV Lopressor (metoprolol) to their pre/post-op patients who are on routine PO doses but can't take it due to NPO status. Current hospital policy say no IVP lopressor w/o a continuous cardiac monitor. The docs argue that the drug is safe in IV appropriate doses w/o a monitor as the pt takes and tolerates the drug on a daily basis. We would not start a pt on the drug IV w/o a monitor...only provide maintenance doses in a pt already tolerating the drug. I brought this to the nursing policy review committee on behalf of the docs and, as my punishment, I inhereted the project. So.....I'm surveying the community for their practices. Please advise! Thanks!

[debbyed]

I would only be comfortable if the patient was monitored. It only takes one patient who reacts differently to the IV push to have a disaster.

[Shae]

Had a pt. just the other night I had to push IV Lopressor on. However, he was on telemetry and his BP was 209/129. This was written as a prn order; not just a now order. Main diagnosis is CVA and his vital sign sheet shows extremely high BP's multiple times during his stay on a daily basis. He could only receive the prn dose Q6hrs.

[New CCU RN]

Originally posted by Shae

Had a pt. just the other night I had to push IV Lopressor on. However, he was on telemetry and his BP was 209/129. This was written as a prn order; not just a now order. Main diagnosis is CVA and his vital sign sheet shows extremely high BP's multiple times during his stay on a daily basis. He could only receive the prn dose Q6hrs.

Scary. It sounds like the management of that pt's medical issues (doctor's fault), was not so great. He really ought to be on a Nitroprusside gtt or some other means to control a pressure like that.... or the patient is at such high risk to have another CVA.

As far as pushing Metoprolol, as an ICU nurse, if I were ever in Med Surg, I would refuse to push it. It can drop someone's HR and BP quite quickly. That is why it is given 5 mL over 5 minutes. We do frequent VS via our monitors when pushing...and it really seems unsafe to have it any other way!!

[PerkyCardiacRN]

Originally posted by FullMoonMadness

Routine or not,I wouldnt do it w/o a monitor. All of our pts. with IV cardiac meds are on a monitor,we let the tech know when the push is started,how much and when it ends,so that the push can have a monitor strip to corelate it.

I'm thankful that we don't have monitor techs. I wouldn't feel safe having someone else reading the monitor while I was pushing the drug. It's my license, not theirs.

We don't have monitor screens in each room, so we bring in the Zoll while we do it.

JMHO