Questions re: drip titration

  1. I was wondering if anyone might share their hospital's policy for titrating pressors and antiarrythmics gtts in the ICU. I am looking for specifics about how often vital signs need to be documented when titrating drips and how the orders are placed by the docs.

    Thanks in advance
    (I am not on my home computer so spell checker is not working....be kind...LOL!)
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  2. 7 Comments

  3. by   deeDawntee
    Ordinarily a Physician will order a parameter. For instance start Levophed 1-12 mcgs/kg/min to maintain MAP >65. When you first start a drip, you take the pressure at least every couple of minutes since Levo's onset and peak are immediate. Once you have gotten the pressure to an acceptable level, every 15 minutes vitals is standard in my ICU. Sometimes the range is not ordered for the med and it is up to us to know the acceptable starting dose. For instance Nipride is started at only 0.2-0.3 mcgs/kg/min to reduce HTN.

    Are you titrating drips? We have more specific parameters for Cardizem gtts. There is a specific protocol. And also there is a Nicardinpine protocol that is used for neuro patients. Other than that, like I wrote above, we are just given parameters to meet.

    Does that answer your question?
  4. by   mcleanl
    Hey Dee,

    Thanks for the response. I guess I am looking for a specific policy versus what is done. For example you mention taking vs q15min once you have an acceptable pressure but how long does your policy say you must continue that. My issue really is this...we have a very difficult policy to follow regarding drip titration. It says EVERY time we titrate up or down we must do vs q5min x 3, then q30min x 4 and then q1hr x 4. So if I am to be in compliance with the policy and I have a very unstable patient requiring constant titration of drips than I really must be doing vs every 5 min (like a bypass patient or something of that nature which requires fairly tight control and can be very labile).
    I've worked in a lot of places but have never seen a policy on drip titration this controlled.
    So I guess I am looking for specific policies that I can bring in to show the "insanity of it all!"

    Thanks for any and all help
  5. by   deeDawntee
    Oh I see,
    The q 15 minute vitals are for as long as the patient is on the drip. The thing is, on the ICU that is not a big deal, because it is all interfaced with our computer system, so all we have to do is "click in" the vitals on our computer record. And, if the BP is out of parameters, and as long as we have the parameters set into our monitors, the out of range BP will set off an alarm and we can titrate the drip accordingly. To be honest with you, every hour is not often enough because so many things can contribute to the BP changing. That is why these patients are ICU patients so we can keep that close of an eye on them. I think you are being asked to be doing way too much in a telemetry setting.
    (Certainly not because telemetry nurses aren't "good enough" but you are just not physically able to keep that close of a watch on that many patients.) I think it is unsafe for your patients and for you.
  6. by   mcleanl
    First, let me clarify, I am in an ICU setting. We don't have computerized charting so I guess I am looking for polices in hospitals that also don't have computerized charting.....yes there are many out there!!! Of course the vital signs are constantly being monitored, I am looking for specific polices related to documentation.
    Thanks
  7. by   deeDawntee
    Quote from mcleanl
    First, let me clarify, I am in an ICU setting. We don't have computerized charting so I guess I am looking for polices in hospitals that also don't have computerized charting.....yes there are many out there!!! Of course the vital signs are constantly being monitored, I am looking for specific polices related to documentation.
    Thanks
    Do you have the GE monitors? Because there is a way to print off vitals from those monitors that you can record on your flowsheets...
  8. by   sweetsmiles2007
    our policy has us doing q15 vitals while the pt is on any vasoactive drips. once they're off the gtts, we go to q30 or hourly vitals depending on how stable the pt is. That can't be easy for you--5 min vitals while your trying to stablize a pt. ugh. When our post-op OH come back we usually have one nurse hooking up and the charge charting and helping out. good luck!
  9. by   Zookeeper3
    Q15 minutes while titrating, then qhr. We don't have computerized charting, but with the endless crashing patient I print off the Q15's from the monitor to the printer, place on a label and sign and date it.

    It's q1hr once done titrating.

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