Titrating drugs: dosages or CC's

Specialties MICU

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Specializes in ICU, Education.

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

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I've been taught to chart by mL/hour. HOWEVER, I've also been taught to know your doseage! Just b/c you have your pump set to infuse by mL/hour doesn't mean you don't know the dose. They just want us to round up or down by mL to have a more even number.

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Dose rate calculator pumps can be dangerous unless the RN knows the mcg/Kg/min.

I was concerned about this the first time they were demonstrated.

It is necessary to know the range of dosages as well as the cc/hr. What if the pump malfunctions? If we give away our practice to a machine our patients will suffer.

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Specializes in Cardiac.

This is where I get confused as a new nurse. When I did my preceptorship, we titrated some by the mL, and some my the mcg. There was no rhyme or reason to it! What's the norm? What would be the best for me to learn?

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Specializes in ICU, Education.

i believe you should always know what dosage your patient is on.

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There are different concentrations.

It's important to know the dose AND volume your patient is getting.

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Specializes in Cardiac.

I agree that you should know both the dose and volume, but how do you know which drugs are titrated according to dose or volume. Some meds we titrated according to mL (Nipride was the last med we did where we titrated it that way) and some meds we titrated by mcgs. Is it a specific drug thing? For instance, is Nipride always titrated by the mLs?

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I don't think it really matters how you go up/down on gtts as long as you know the dosage. Drugs are dosed mcg/kg/min, but the titration is patient driven. So to me as long as the dosage is in an acceptable range the way I'd titrate matters little, as the hemodynamics are more important that the actual dose.

Like if a pt. is on 10mcgs/kg/min on dopmaine and im weaning i might cut it down to 8-9mcg/kg/min and the reevaluate based on response.

Or if they are on 30ml/hr and I'm weaning I might cut it to 23-26ml/hr then reevaluate based on response and hemodynamics.

I've seen both and I think it's nurse preference, fairly certain no drugs are strictly titrated in ml/hr. The bottom line is with titration the dosage isn't as important when weaning/increasing as is the desired response so either way gets the job done. It's still your job to know the actual dosage and if its in a therapeutic range. My preference is mcgs/kg/min as its more exact without going through the math. Hope that makes sense.

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For Nipride we use micrograms per kilogram per minute AND include the volume when charting.

Some hospital protocols use different concentrations. Sometimes a physician orders a different concentration or they come from the ER with say 100mg in 500cc when we routinely use 250cc.

To calculate mcg/kg/min

Drug mcg/ x cc/hr

Solution cc x 60 min/hr x kg = mcg/kg/min

Example: Nipride 100 mg/250 cc D5W was ordered to decrease your patient’s blood pressure.

The patient’s weight is 143 lbs, and the IV pump is set at 25 cc/hr. How many mcg/kg/min of Nipride is the patient receiving?

100,000 mcg x 25 cc/hr

250 cc x 60 min x 65 kg = 2,500,000

975,000 = 2.5 mcg/kg/min

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Specializes in Cardiac.

I know how to do the math. When I was titrating Nipride on my fresh open heart 2 weeks ago, my preceptor said, "just keep that MAP at 70 and titrate 5mL back or 10mL up to keep it there". So I just didn't know the rules as they pertained to each drug.

TopherSRN, that's the answer I was looking for! Thank you! I start MSICU this June and I want to learn as much as possible before I get there!

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I know how to do the math. When I was titrating Nipride on my fresh open heart 2 weeks ago, my preceptor said, "just keep that MAP at 70 and titrate 5mL back or 10mL up to keep it there". So I just didn't know the rules as they pertained to each drug.

TopherSRN, that's the answer I was looking for! Thank you! I start MSICU this June and I want to learn as much as possible before I get there!

You're going to be great!

Keep questioning and reading those policies and procedures.

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Specializes in Cardiac.

Thanks! I start this June, so you guys will be hearing me ask a lot more questions soon!

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