Titrating drugs: dosages or CC's

[dorimar]

I was hoping for some input on the way things are being done elsewhere. I was always taught that you must know the dosage your patient is on of any titratable medication. This is common sense as far as i am concerned (ie max dosages, side effects and complications of drugs at certain dosages, and just to have an overall picture of how the patient is doing-- ie yeah his map is 70 but he's on 30 mcg of levo and 100mcg's of neo). I have always known my dosages even if i had a pump that didn't titrate by dosages and i had to tirtate by CC's I knew my constant , so every change, i knew my dose. Gees when i first started nursing we always had to calculate it because there was no such thing as dose calculator pumps. I am at a new job in a level 1 trauma teaching facility. I am shocked to find that most of the nurses have no idea the dose of their titratbale drugs, and many are even CHARTING their titrations by cc's (ie: Neo increadsed to 14 cc/hr). I took care of kid the other night & His propofol was at 25 cc/hr which calculated to 67mcg/kg/min. Now i know for a fact the prior 2 nights his nurse had the propfool at 50 cc/hr because i answered his pumps more than once. That means they were running his propofol at 140 mcg/kg/min. So wrong. Just interested if this is a trend where they don't have dose rate calculator pumps.

Doris

[chaosRN, ASN, RN]

I'm sorry cardiac, I missed the point of your post. I was not distinguishing between titrating and actual charting. I will tell you in my practice, 99% of the time I titrate based on drug dose. Now, I know if I start a Ntg gtt at 3cc/hr how many mcgs I am at, and some of our nurses will titrate Ntg by cc. I think more than anything it's because we have a fresh heart come back that we don't want to blow grafts on with high bps, it's quick to turn the ntg gtt on at 30cc and not have to program it in the pump if you need it immediately. My practice is to set my pumps up when the patient admits so if I need my ntg/heo gtts I can turn them on a titrate based on dose-it's the safest way in my oppinion.

However, there are a few times I titrate based on cc not dose. Example is a cardiogenic shock patient on epi. When you're weaning slowly say you are at .02 mcgs, the patient may not tolerate coming down to .01 mcgs, but the pump won't let you do .015 mcgs, so I'll come down in the ccs to titrate slowly. So, if .02 mcgs is 6 cc for that patient and .01 is 3cc I may go to 5 cc, then 4 cc, then 3 cc, just so it is slow enough the patient can tolerate it because from 6cc to 3 cc may be too big a jump. Vasopressin can be the same way when you're weaning a sick sensitive patient. However, in any other drug-cardene, ntg, dopamine, levophed I always titrate by the dose.

I agree. Also it's important to know the dosage. like someone else said, because of different concentration mixes. Especially in the renal pt where all gtts are max concentrated.