Anyone ever use IV Glycopyrrolate?

cathys01 · Jul 18, 2008

We use it in the adult CVICU as an adjunct to neostigmine for the reversal of the paralytic agents used in anesthesia.

It is an anticholinergic, parasympatholytic agent, and causes elevated heart rate and yep...dry mouth...

I agree with you though, that it sounds more like this baby is having seizures. Could the seizures be leading to the vagal response you are seeing (decreased HR, etc.)? Is the baby on any anti-seizure meds? Have you seen an improvement since the glyco drip was started? And, just curious, what sort of dosing do you do on a baby?

(disclaimer: I did NICU for 2 years before heading over to CVICU, and have never seen glyco used in this population...)

elizabells, BSN, RN · Jul 19, 2008

I'd have sworn they were seizures too, but the team says no. He gets stiff as a board and his eyes roll back in his head. He did have an abnormal EEG, but no evidence of seizure activity during the episodes. He's not on a drip, it's q4h and I think... 5mcg/kg/dose? I'm not there right now, so don't quote me.

BTW, Steve, he did it again the next night. Compressions and atropine. Poor little bear.

BittyBabyGrower, MSN, RN · Jul 19, 2008

We have used it and still do, but only on the older, chronic kids. This med has benz. alcohol in it and shouldn't be used on kids less than 30 days (I think that is the cut off, don't quote me). It can also cause cardiac issues such as brady, block, and BP issues. We mostly use it on the bigger kids that have excessive secretions.

Sounds neuro to me too, or a hypoxic event can cause those same symptoms. But it could be the benz also. I hate when these kids give the vague things you just can't pinpoint!

cjcsoon2bnp, MSN, RN, NP · Aug 13, 2010

I'm not sure I'd be much help. I've only seen it when our Peds. ER does conscious sedations on kids, we use it for its anticholinergic properties.

!Chris :specs:

SteveNNP, MSN, NP · Aug 13, 2010

I chuckled when I read this old post of mine... that baby has now been home for almost 2 years... and is doing pretty well! His mom keeps in touch with me via Facebook... he is getting ready to start his early-intervention preschool program...

prmenrs, RN · Aug 13, 2010

The kids that take a few years off your life!!

cjcsoon2bnp, MSN, RN, NP · Aug 13, 2010

I chuckled when I read this old post of mine... that baby has now been home for almost 2 years... and is doing pretty well! His mom keeps in touch with me via Facebook... he is getting ready to start his early-intervention preschool program...

Steve I know its a little OT but... Don't you worry about patient-nurse boundries when you allow parents to contact you outside of work (in this case Facebook). I realize that NICU is a world in its own and so maybe different rules apply in this case, I donno I was just wondering your take on it.

!Chris :specs:

ittybabyRN, RN · Aug 13, 2010

Steve I know its a little OT but... Don't you worry about patient-nurse boundries when you allow parents to contact you outside of work (in this case Facebook). I realize that NICU is a world in its own and so maybe different rules apply in this case, I donno I was just wondering your take on it.
!Chris

I know you weren't asking me but I'll give my take on it...I am a very new nurse though but just through observing the goings-on at my unit I have noticed that many many families keep in touch with the nurses, through email, facebook, visiting the unit after other apps at the hospital and for those families who had primary nurses even through visits outside the hospital. I think if the family wants to maintain the relationship and its not crossing boundaries (such as having an old nurse babysit a medically complex child which could lead to problems if something were to go wrong) then it is fine. There have even been nurses that have babysat old pts though I don't think I would go that far. I just recently discharged a primary of my own to the local pedi rehab facility as his stepping stone to home, he has a 16 year old mom and he has a trach/gtube and a likely progressive diagnosis, I spent 12 hrs a day, 3-4 days a week for 4 months with this baby and his family, of course we are going to keep in touch, I am also planning a visit in a few weeks to see him in the rehab facility. I would never consider babysitting or partaking in any of his cares outside my current work environment but if the family wants to maintain relationships I don't see it as a problem so long as we all know the boundaries. I know plenty of nurses who have also attended funerals at the families requests, during the hard time of having a baby in the hospital for weeks to months I think the families often feel very attached and a lot of gratitude to those people they spent so much time with, for some it's a hard relationship to break suddenly, for others its a necessity, all depends on the people.

littleneoRN · Aug 16, 2010

I keep in occasional contact with special families. My standard is to give them my work email. I don't like mixing work and Facebook, even though I make sure my Facebook image is professionally presentable. I have met a few former families for dinner and get cards and pictures in the mail. I will also attend a funeral if it's a primary of mine. I think this amount of interaction is fairly common in the NICU world. I'm careful of the things I say and write to maintain a professional relationship with healthy boundaries.

SteveNNP, MSN, NP · Aug 18, 2010

I keep in touch with a few special families via facebook, and keep pretty tight control on what they can see via limited profile options, etc. They are all families I formed a close relationship with, and I appreciate being able to see the kids as they grow up.

As long as they respect boundaries, as I expect of all my facebook friends, I have no problem with it.

Maybe NICU is different. Once you take care of a baby for 4, 6, 8 months, their family sometimes becomes YOUR family. A lot of our nurses sometimes per diem as home care nurses for their primary babies after they go home. Some are godparents to these kids too...it's a different world than adults, I guess...

twinkletoes53 · Aug 21, 2010

It IS a different world than adults, Steve. Our NICU has always counselled its nurses on getting too close to their patients and families. I have attended funerals of my primary babies. So have their attending Neonatologists. I try to limit my contact with my patients after discharge, but I still receive updates from the mother of an infant I cared for 12 years ago who lost his vision to ROP, and the family of an infant who is severely disabled, and who is now 3. Both these babies were my primaries. AND, the mother of a baby I cared for 20 years ago found my name mentioned in a newspaper article, and phoned me at work! She remembered that I had been her daughter's primary RN, and that I was the first one to let her hold her baby after she'd been on a vent. for months. She said I had 5 people assist me. I remembered her, her daughter, and what I'd done, but not the details. Her daughter passed away at the age of 5 due to complications of her illness. For her mother to remember me after 20 years floored me, but it gave me a concrete example of the impact we as nurses have on our patients and their families.

Some of our nurses do work as pe diem nurses for their patients. We had an infant who was discharged with a trach. and on a home vent., who is now 3. Several of his nurses hlep care for him at home. You have to be careful because of legal and liability issues.

But then again...the cover of the latest issue of "Neonatal Nursing" featured an RN who had kept in touch with 2 of her primaries for 30 years. She had an article on the last page of the magazine entitled "I danced at his wedding", which described the day that she did dance at the wedding of one of her primary infants.