Asked to give an anesthesia medication

[laurencsmile]

Hi all,

I was asked this week to push Glycopyrronium PRN for symptomatic bradycardia on a mother-baby floor if my patient became symptomatic for a hr in the 30s after a c-section (hr in the 50s prior). I told my charge RN that I did not think this medication was an appropriate PRN due to it is not in ACLS protocol and I work on mother-baby, not PACU, where the patient is not monitored by an ekg machine. She responded that I was making excuses because I 'didn't want to give a new medication that I hadn't given before'. I do not think that an unmonitored 'med-surg' type floor for healthy moms and babies was an appropriate place for this patient to be with episodes of symptomatic bradycardia (hr in the 30s). I also don't think I should have been ask to give a PRN anesthesia medication on this type of floor. Any thoughts? am I overreacting?

[guest1147324]

You can always check your facility's policies on high risk medications - they typically have a chart with the med and where it can be administered/who can administer/monitoring/etc. I don't see this med listed as an anesthestic, though. It's used during anesthesia to reduce secretions since it is an anticholinergic. You should always advocate for your patient if they may need a higher level of care - I always give my charge nurse a head's up if I have concerns about a patient.

Your CN sounds like an ***.

[LovingLife123]

Why do you deem this an anesthesia medication? This medication is given all the time especially in end of life situations to dry up secretions.

[NICU Guy, BSN, RN]

16 hours ago, SweetElla said:

It's used during anesthesia to reduce secretions since it is an anticholinergic.

This what have seen it used in conjunction with succinylcholine administration. I don't work post-partum, but it seems like this would be common for C-sections under general. It seems like the bradycardia events would be short term until the anesthetic has been fully metabolized. Are you a new nurse or an experienced nurse new to OB?

[klone, MSN, RN]

This is an anticholinergic, similar to atropine, I would assume. It's not an anesthesia medication.

[KatieMI, BSN, MSN, RN]

1) this is not "anesthesia" medication. This is a medication you do not know.

BUT:

2) it is just basic clinical logic: if you gonna administer something acutely affecting heart in any way, you must have some mean to control its action, such as tele. Whatever it might be, known or unknown.

No tele monitor - no push. Plain, simple. Policy or not.

[WestCoastSunRN, MSN, CNS]

3 minutes ago, KatieMI said:

1) this is not "anesthesia" medication. This is a medication you do not know.

BUT:

2) it is just basic clinical logic: if you gonna administer something acutely affecting heart in any way, you must have some mean to control its action, such as tele. Whatever it might be, known or unknown.

No tele monitor - no push. Plain, simple. Policy or not.

indeed.

[JKL33]

1 hour ago, LovingLife123 said:

Why do you deem this an anesthesia medication? This medication is given all the time especially in end of life situations to dry up secretions.

The OP is not familiar with the medication and the perioperative period is what s/he associates it with. Regardless, an unmonitored post-C/S patient out on the mother-baby floor with "symptomatic bradycardia" isn't an end of life patient needing his/her secretions dried up.

***

It seems like if the charge RN was any more familiar with use of glycopyrrolate in this scenario than the OP, maybe s/he would have given proper resources/instruction instead of making a dumb accusation. ?

***

12 minutes ago, klone said:

This is an anticholinergic, similar to atropine, I would assume. It's not an anesthesia medication.

Was just thinking of you when I first read the question. Is this a common thing that RNs working in this area would go around squirting robinul PRN for "symptomatic bradycardia" on unmonitored post-C/S patients? [Also, is this most likely lingering from spinal/epidural anesthesia?]

[klone, MSN, RN]

1 minute ago, JKL33 said:

Was just thinking of you when I first read the question. Is this a common thing that RNs working in this area would go around squirting robinul PRN for "symptomatic bradycardia" on unmonitored post-C/S patients? [Also, is this most likely lingering from spinal/epidural anesthesia?]

Nope. If we had a patient with symptomatic bradycardia, we would be advocating getting her on a tele floor, or at least on portable tele monitoring. And if the bradycardia is d/t the anesthesia, she should not have been moved to the floor from PACU. She's not stable yet.

[kp2016]

I have administered Glycopyorrolate many times for bradicardia. It is not an “anesthesia” drug and certainly isn’t outside the scope of practise of an RN.

[JKL33]

Just now, kp2016 said:

I have administered Glycopyorrolate many times for bradicardia. It is not an “anesthesia” drug and certainly isn’t outside the scope of practise of an RN.

Inquiring minds want to know: In what setting/circumstances?

Thank you (just trying to learn something here)

[chare]

24 minutes ago, JKL33 said:

25 minutes ago, kp2016 said:

I have administered Glycopyorrolate many times for bradicardia. It is not an “anesthesia” drug and certainly isn’t outside the scope of practise of an RN.

Inquiring minds want to know: In what setting/circumstances?

Thank you (just trying to learn something here)

Agree. I am more familiar with using atropine for this, however, from what I have found after seeing this post glycopyrrolate seems to be as effective in mitigating the bradycardia, and is less likely than atropine to result in tachycardia.