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Ambulating a pt while on vasoactive drugs?

CCU   (4,459 Views | 11 Replies)

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Usually with heart pts, we try to get them up on POD #1. I've gotten mixed responses from my colleagues (yes you can ambulate them / no you cannot ambulate them) while pt is on vasoactive drugs. What is the real answer and reasoning behind why someone can or cannot ambulate while on these drugs?

Thanks in advance!

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ArmaniX has 5 years experience as a MSN, APRN and specializes in Surgical Critical Care.

295 Posts; 6,581 Profile Views

I would say no.. in our unit (not ccu) if a patient is on pressors they do not even get OOB to chair. Pressors=instability. Once the pressor is weaned off we can talk.

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MunoRN has 10 years experience as a RN and specializes in Critical Care.

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By itself, being on vasoactive drips is not a reason to not get somebody up. There is sufficient evidence to say with some certainty that being irrationally careful and keeping them in bed will do more harm than good. We aim to extubate fresh hearts within 4 hours of arriving in ICU, we then dangle them as soon as we can get things situated after extubation, they're up to the chair (stand and take a few steps) before breakfast, and the majority of patients are still on a little bit of something vasoactive at least through the morning after surgery. The only things that would prohibit ambulation would be a device where ambulation is contraindicated, or if they are syncopal/acutely hypotensive with activity, in which case they need volume, so we give the volume and go right back to getting them up.

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SubSippi has 2 years experience.

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It depends on the pressor and it depends on the patient.

You're getting mixed responses because there isn't a straight answer. Your best bet is to take things slow, and see what the patient can tolerate.

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88 Posts; 2,382 Profile Views

We don't have a policy on it, and it really depends on the patient. Most of the time I'll sit them at the edge and see how they feel/get a set of vitals before doing any more movement. Now if someone is on max doses of pressors or more than 1 I'm more cautious, and put the bed in a chair position first.

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BlueChocolateCat has 2 years experience and specializes in CVICU, CCRN.

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We do not have a solid policy. It really comes down to nursing discresion (unless the docs insist)

In our unit, we are able to give small neo pushes during moments of severe hypotension (MAPS

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SubSippi has 2 years experience.

907 Posts; 12,712 Profile Views

We do not have a solid policy. It really comes down to nursing discresion (unless the docs insist)

In our unit, we are able to give small neo pushes during moments of severe hypotension (MAPS

I don't mean to sound accusatory at all, but I'm curious... How are you guys able to give neo pushes? Are you actually allowed to do that (like you would scan it and keep a record of you having given it in the e-mar), or is it the sort of thing where technically you're not supposed to but people on your unit just use the syringes anesthesia left sitting around? I'm asking because I've seen the occasional propofol bolus given when someone suddenly wakes up and looks like they're about to extubate themselves...even though I was also told that's practicing anesthesia without a license. But it still happens.

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32 Posts; 1,363 Profile Views

We do it quite regularly with patients still on dobutamine or levophed. While we don't have orders to use neo pushes like another poster said I always have fluid ready to gravity bolus through the patient's right IJ. 50-100cc NS fluid bolus will usually fix any transient dizziness or hypotension in my experience.

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1 Post; 289 Profile Views

I also have access to 'Neo sticks' which we use directly post-op or when a pt is getting OOB for the first time - there is a standing order on almost all post-op heart pts for the Neo in cases of low MAPS (as well as Nitro in cases of severe hypertension but this doesn't get used nearly as much) but most nurses do not end up scanning after they push a CC.

I've worked in a few cardiac ICUs and only come across this once and it's admittedly a pretty large trust of autonomy and nursing judgement.

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24 Posts; 920 Profile Views

Have the pt stand. Retake bp and monitor s/s.

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Pheebz777 has 18 years experience as a BSN, RN and specializes in ICU, CVICU, E.R..

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We do it quite regularly with patients still on dobutamine or levophed. While we don't have orders to use neo pushes like another poster said I always have fluid ready to gravity bolus through the patient's right IJ. 50-100cc NS fluid bolus will usually fix any transient dizziness or hypotension in my experience.

wow, 50-100ml? When a patient is that volume depleted to cause dizziness, 50ml is like a drop in the ocean. I usualy give at least 250mls right off the batt. Especially when O.R. sends a patient up right after a push of Neo. You kinda wonder sometimes why they have 10cc syringes in their pockets lol!

To answer the OP, the goal is to ambulate as soon as possibly tolerated. Getting them to the chair, dangling feet, repositioning, etc. Some are even stable enough to walk to the bathroom. It varies patient to patient.

Edited by Pheebz777

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MYSTICOOKIEBEAR has 5 years experience and specializes in Cardiac/Transplant ICU, Critical Care.

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It really just depends on what kind of pressors the patient is on, reasons for being on those specific pressors, the doses the patient is on, and the patient's overall clinical picture. If they are on 0.08 on vaso, 10 of levo, 5 of epi. I would say no. If they were on 2 of epi, 3 of levo, 0.02 of vaso, steady on their feet and on room air, I would say yes. It also really just depends on your hospital policy as well.

I used to work on a CVT stepdown and we had patients who were OOB UAL on 3 and 3 of Dop and Dob for a few days sometimes. So when it comes down to it, look at: A) Clinical picture and B) Hospital Policy

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