We would like to set up protocols where nurse wean and titrate drips, E.g. DA ,DBT, NTP, Milrinone etc.This is a peds CTICU. Anyone out there doing this? Could i see your protocols?
Jul 22, '04
i don't think we have protocols per se, since we always get specific patient-appropriate parameters on which to titrate our drips. our orders would look something like this:
titrate epi by .01 mcg/kg/min q30-60 min to maintain sbp 60 - 80 and map >45. notify md if epi >.1 mcg/kg/min. do not wean below .05 mcg/kg/min. when epi @ .05 mcg/kg/min for > 1 hr, begin weaning norepi to same parameters.
titrate nitroprusside by .01mcg/kg/min q30-60 min for sbp ,< 80. when nitroprusside is off, start captopril .05mg/kg q6h if sbp > 90.
our drips are mixed so that 1 ml = xmcg/kg/min (or hour) so titration is quite simple. we generally don't wean milrinone in the same way, we'll give a load, run it a .75 mcg/kg/min then when the need for afterload reduction decreases, we'll drop the dose to .5 mcg/kg/min, then stop it at some point. we can send patients to the surgical floor on milrinone, but often don't.