Ativan, insulin, alcohol drips on floors?

gpip · Apr 9, 2002

we use insulin and ativan gtt routionely in ICU. Insulin with sliding scale however the scale is written Q1-4 hrs. Ativan gtt for sedation of some ventilated patients if they are too restless or are paralized. I have seen 1 alcohol gtt a few years ago as a way to easy ETOH'er through severe DT's. vitals on the unit are standard Q1 hr. Check sedation Q2-4 Hrs using ramsey scale. standard policy in our facility is all medication infusions must be on IVAC's.

misti_z · Apr 9, 2002

Like I mentioned before our insulin gtts are adjusted per q2h BS checks and with 5 other patients it is hell. Thank god for wonderful techs!! :kiss

We often have heparin gtts as well. Our hospital protocol is q6h ptt.

Fgr8Out · Apr 9, 2002

We get patients who require ETOH or Insulin infusions (drips) on our Med-Surg floor. We don't LIKE it, because of the time involved with monitoring VS, Accuchecks and the Patient themselves. We DO try to adjust the patient load according to Acuity, but on nights that's darn near impossible (RN's have upwards of 10 patients, with a CNA for every 15). When possible, we do try to have these patients kept in ICU.

Enjoy reading all the comments!

sharann, BSN, RN · Apr 10, 2002

I have actually heard of a caffiene drip or bolus used as a treatment (symptomatic) of post spinal-anesthesia headache. I read it in the Journal of Perianesthesia Nursing. How many times have I wished for a caffiene drip and lokk, there IS such a creature. Now the ETOH drips? That I never heard of , so thanks for the new info everyone!

Do pts get "drunk"on ETOH drips or is it "theraputic" rather than a good rush?

RNforLongTime · Apr 10, 2002

I have worked at two different facilities. At both places, we did insulin and heparin gtts on the med/surg floors. At my present hospital, we can do dopamine gtt on the tele unit but ONLY if the pt had the gtt initiated in ICU--it is not initiated on the floor. Also, they do not allow Nitro, Cardizem gtts on the floors. At my old hospital, Nitro and Cardizem gtts were allowed on the cardiac floors--they weren't limited to ICU.

mattsmom81 · Apr 10, 2002

Never seen a pt buzzed on ETOH drip---it's used to keep out of DT's or to counter antifreeze ingestion...just a small amount of it.

Still can't believe non-DNR narcotic infusions (other than PCA's) and hourly insulin titrations are put on medsurg floors...hope you folks have some very good CYA policies to protect you and your patients. I can't imagine having 7 or more patients and still be able to keep a close enough eye on them to head off complications.....Heparin is OK as just q 4-6 adjustments and pt is stable.

We would take them on stepdown with a centrally watched monitor that displays vitals, rhythm and o2 sats...nurse patient ratio 1:4 or 5 at most, no CNA to help but monitor tech watching at desk.

I still don't think 'hourly' ANYTHING needs to be on medsurg...am I being old fashioned, guys?? Hourly insulin needs to me = too close to DKA with potential lyte imbalance, metabolic instability, etc.

If someone is unstable enough with his diabetes to require hourly BS checks he deserves a more acute setting, IMO, as does a violent patient requiring Ativan infusion. But hospitals will push as far as they can, won't they? Particularly when all monitored beds are full, I know, I have been there too.....

We all have our comfort levell with this stuff, I guess.:) Like the old sarg on Hill Street said, "Let's be careful out there..."

susanmary · May 18, 2002

Regarding ETOH IV infusions via central lines -- do you infuse 10% or 20%? Regular floors? ICU? Stepdown? Do you feel a 20% ETOH infusion with an epidural infusion at the same time is appropriate for a stable floor patient? Would YOU accept this patient on a regular floor? I'm trying to get a handle of the acuity out there.

fedupnurse · May 18, 2002

There is a reason why hospitals have ICU's with far lower N;P ratios than the med surg floors. I wouldn't be comfortable with any of these on a med surg unit. I've done the alcohol drip a few times, insulin drips we do all the time and ativan drips are only permitted on vented patients. You guys on med surg can't possibly have the time or equipment to monitor for resp depression, bradycardia or apnea. How about the insulin gtts when they bottom out? It isn't safe. One of our managers thinks we should send patients with TPA gtts. from Specials to med surg floors. I told her she was crazy! They have anywhere fro 8 to 15 patients a piece and no back up. What do you want the poor slobv to bleed to death? She didn't answer. Surprise!!

OBNURSEHEATHER · May 18, 2002

Originally posted by efiebke
Has anyone heard of a caffeine gtt?!?!?

Sometimes anesthesia will order them for spinal headaches on our post partum moms.

Heather

mattsmom81 · May 18, 2002

Susanmary, the ETOH drips we infuse are 20% and if used to prevent DT's and the patient is STABLE and nonviolent, this would be OK on the floor at my hospital, as policy permits.

Epidural infusion of narcotics always require a monitored bed at my facility, with continuous pulse ox display on a central monitor, and hourly respirations (usually we set that up to display on the central monitor too). This is policy at my hospital, so we even get OB/Gyn patients post procedure at times... Any patient requiring 'hourly' anything generally goes to PCU/stepdown or ICU depending on how stable the patient is. Medsurg has no time for ongoing hourlys that are likely to become unstable (DKA's or epidural narcs) with the patient load they get, so this seems logical to me...

What's everyone else experiencing out there??

PhantomRN · May 19, 2002

Where I used to work it went like this. We did ativan, heparin Insulin if necessary.

Insulin drips went to tele or renal floor....Q2-3 hr sugars. If it was Q1 hr it was supposed to go to the unit......but hey you know how that goes.

Ativan drips to oncology, DNR pts...alot.

Heparin, dopa, cardizem, milronone to tele.

The only thing that absolutely had to go the unit was Levo, nipride etc.