Pushing 50mg of IV Lopressor? Tell me no !

Specialties Radiology

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I've been working at the outpatient imaging center and loving it. I was asked yesterday to cross-train for nuclear medicine. When doing the cardiolytes they give Lopressor IV to bring the HR down. The protocol is 5mg Q 5-15 minutes up to 50mg. The patient then goes home. That scares me to death and I think I would have to refuse to push that much total IV Lopressor? Any thoughts?

Specializes in OB, M/S, HH, Medical Imaging RN.

First Welcome to AllNurses!

When I first posted this thread I had only ever given Lopressor 5 mg IV on med/surg. It was a big deal. We had to have someone watch the telemetry while we were pushing it.

Now I've been pushing Lopressor for CTA's for about 9 months and am comfortable with it. We give an initial 15mg IV over 5 mins. If after 15 minutes the HR is not around 60 then we push an additional 35 mg over 8 minutes. Of course the patient is monitored and VS taken Q 2 mins. I have found that the majority of the time if the first 15mg don't work the additional 35mg doesn't have much effect. If we do an inpatient we take them directly back to the floor, same with ED patients. Outpatients we monitor for an hour and then release. No manitory driver. I've heard some depts give PO Lopressor the night prior and have very good results.

thanks for your quick reply, we have been practicing for about 9 months too, it still freaks me out, but our patients do well. The contrast seems to bump their pressure and pulse back up before they leave, my concern is max effect is about 40min and we are only keeping about 10-15min after, sometimes 30min. And the half life is 4hrs, so how are they at home or driving? I have not heard back from anyone that they have had trouble. Our pt population of course is elderly with most of them on betablockers already and lots of other meds. They also have some heart disease.

I have another question about patient history and paper work is there another thread for that we are trying to get organized, but with only 1 nurse per day (we job share) we are responsible for all the pt's history, meds and looking for lab results. Calling for allergy to contrast and mucomyst before the scan. So we are pretty busy even if only 6 scans a day, and if we do 9 it is crazy.

Specializes in OB, M/S, HH, Medical Imaging RN.

I gotta get to bed but I'll get back to you tomorrow on that. Promise.

Specializes in Emergency Department/Radiology.

If you are in need of a history sheet/documentation tool let me know I can fax you one of ours. We have one that has now been revised. As far as written protocols I think that is MD dependent in your facility.

I attended a Coronary CTA Seminar in August. They routinely push 50mg lopressor and even go as high as 100 mg of Lopressor for coronary CTA's and then monitor the patient for only 30 minutes prior to sending them home. I explained to them that I was very concerned about the doses, they looked at me as if I had just fallen off the turnip truck. (This was a outpatient clinic that was affiliated with a cardiologist office, yet they performed this exam often when there was not even a cardiologist on site).

Besides my concern regarding the amount that was being administered for obvious patient safety reasons, I suggested that that they had a little more freedom to manage these patients than we did as we are a hospital based Radiology department and therefore subject to regulatory agencies such as JCAHO, TDH, CMS etc.

My personal experience if 25-35 mg of Lopressor does not obtain the targeted heart rate of 55-60, then you are better off canceling and approaching heart rate control a little differently. Our refering cardiologist have had great luck with premedicating with 50mg PO Lopressor BID for 2-3 days prior, then we administer IV lopressor as needed the day of. These patients seem to respond much easier to the IV with the premedicaion on board.

Hope this helps.

I once pushed Lopressor 5mg 23 times, I told the attending I was not comfortable & the Cardiologist was at the bedside teling me that was a proper order, I involved Pharmacy & Nurse educator. No one found any literature to support that it is unsafe so long as the pts lungs are clear, no CHF, & not brady. The MTP didn't even touch the. BP pt. I still think of it cause I don't know if that waas even right.

The pt. did live BTW he was on a nitro drip maxed out at 200mcg per min., & with MTP every 5min ATyed like at 200/100 with hr 90ish

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