Ativan, insulin, alcohol drips on floors?

talaxandra · May 22, 2002

I work on a mixed medical specialty unit (stroke, neurology, renal, endocrinology) in Australia. We have minimum ratios set by law to 1:4 AM and PM shifts, 1:8 on nights (higher if warranted by patient acuity).

Depending on the stroke protocol, half of them will be on heparin infusions, or none of them. If they're on urokinase or streptokinase they're specialled (1:1) until the infusion's been down for four hours.

We use insulin infusions via syringe driver for DKA - 1/24 checks and hourly rate changes depending on the BSL.

Our migrainoid-withdrawal patients have 10 days of continuous, low-dose lignocaine infusion and have a bedside cardiac monitor.

Lots of our patients have narcotic infusions, and we push IV narcotics, with no special monitoring. If they're being palliated they might also have a midazolam infusion, but that's usually given s/c. The renal patients are sometimes on a frusemide infusion, monitoring ditto.

If they're on GTN or dopamine then they have 1 - 2/24 obs once stable. Amiodarone drips have to go to cardiology or to coronary care.

Hope this helped :)

Tara

Nurse K-Bear · May 23, 2002

I am an LPN. I work on a surgical floor. Some days I feel like I should be working in ICU. We give Ativan IV push. The MD kept on asking me why my patient did not recieve his Ativan right after she ordered it. I communicated it to the RN who was busy with all of her patients. I swapped some tasks with her so she could do all my IV push meds. After this the MD ordered them PO. We also do heparin and insulin drips on our floor. As LPN's we can maintain on a PICC line, but have to get the RN to connect and disconnect them. With a Peripheral line, we just need to keep the RN updated. I am really nervous when I have patients with these drips, but it is not to often. CNA's take the vitals Q2 depending on the patient situation.

Enabled · May 23, 2002

Nurse K-bear, in Florida LPNs maintain all perifpheral lines. They do not do any IV pushes or hang blood. Usually the RN hangs and then the LPN who has that patient monitors it. I don't know why this restriction exists because it hampers everyone. I would switch off when I had an LPN on my team. I would take the patient that required IV pushes and she would take one of mne. I know that some LPNs hang blood and sign the form as a second signature or go ahead and give IV pushes. I don't agree with it but I know it happens particularly on a busy floor. Don't give into an RN saying you go ahead and do it. DON'T DO IT or you will be out of a job in no time. It is too risky especially if it is a med that is specialized or if it is not diluted or even the wrong med because it looks similar to what. As I always say no matter what level you are at watch your butt.

KaraLea, LVN · May 23, 2002

When I was working Med/Surg, all of these drips were in the ICU.

Enabled · May 24, 2002

As far as the Ativan, Alcohol and other drips, which the facility did not have one on the alcohol they had a rolevice that was suppose to work just as well or ALMOST as well as a pump. You still had to figure the number of drops per minute and set the roller to the closests amount. The reason my patient was on it was that they did not want him going into DTs either before or after surgery. I have given Ativan IV but not as a drip. We do insulin drips with a protocol as how often bs were done by fingerstick as well as by lab. We always kept the glucagon and DW50 tape over the headboard in the event there were additional problems. I have given Ativan IV and have recieved it IV but I have not hung it. I would onlly give cardiac meds without a complete inservice of the meds so that I don't have to stop at the last minute to look it

BugRN · May 24, 2002

Anyone ever hear of heparin drips on Post partum??? That 's the point when I quit. 1 RN w/ and aide or LPN w/ 10-14 post partums, post-ops, antepart's, surgical hyst.'s etc...Oh but we did get a 20 min inservice! That was also the same time they started sending us Chemo pt.s too, Infection control said it was OK, amazing isn't it!!

Enabled · May 24, 2002

BugRN, the only reason I can see a heparin drip is if the mother had develop a DVT but she should be exercising her legs during the post partum period. I would not want it on the floor, but would you want to seperate the mom and baby by being on different units. I can see why they have chemo on your floor as there is little ristk of diseases as I would think the fresh deliveries and post ops would be considered a clean floor. We had our chemo patients on the surgical floor at one end. Anyone who developed and infection was sent to one end of the floor and put on contact precautions as a reminded for infected materials. That way hopefully there won't be cross contamination

RNinICU · May 27, 2002

We use ativan, fentanyl, and diprivan drips on vent patients for sedation. Depends on the patient's condition and diagnosis which one we use. Hourly vitals of course. Insulin drips for DKA or hyper glycemic patients.

mattsmom81 · May 27, 2002

Our post partum wing doubles as a clean female overflow area...so they are expected to know how to care for medsurg patients. Most of the nurses there also float to medsurg to keep their skills up.

So yes, a Heparin drip would be an OK standard procedure on my postpartum...it's only q 4-6 PTT parameters and a fairly low risk procedure. Our chemo patients go EVERYWHERE ...the only stipulation is a chemo certified RN must initiate the chemo and be available to the staff for support/questions.

caroladybelle, BSN, RN · May 27, 2002

I personally think that chemo patients should be on a designated floor so that chemo nurses can teach and observe for dangerous or uncomfortable/detrimental side effects. At my current facility, unless on the vent, they all go to Oncology. However, I am aware that the suits in nursing do not think this necessary (a nurse is a nurse is a nurse, etc.) The oncos in this area however require (if at all possible) that chemo patients go to a hospital/unit designated for oncology.

Any chemos on other floors (including the unit), are initiated by a chemo nurse. If continious, monitored q2 hours or more often by a chemo nurse. All ports accessed by a cancer nurse - since an incident in the area, where a port was accessed w/a coring needle. And we frequently go to ER/L&D to give methatrexate for OB/GYN or rheumatoid arthritis patients. The OB nurses pay us back when we need fetal heart tones on one of ours. Team work is wonderful.

We also frequently advise or assist with IV Ganglicyclovir (requires chemo precautions)

moonshadeau, ADN, BSN, MSN, RN, APN, NP, CNS · May 28, 2002

I don't think that IV insulin gtts is such a big deal. Of course though we are used to having a very aggressive Endocrinologist that writes all kinds of screwy orders. The insulin gtt we do checks q1 hour until sugar stabilizes and then it goes to q2-3 hours. We don't do the bedsides, the lab does them. That helps. But then we are also used to having to recover angio caths that require hours of frequent vitals so that might be a part too. Time management is everything! Ativan, ETOH and NTG, Cardizem are all upper care units. I work on a tele floor that is closer to a step down some days, but day and evening ratio can be 1: up to 6 and noc 1;10.

fiestynurse · May 28, 2002

Never heard of Alcohol or Ativan drips. Insulin drips are done in the ICU only - Never on Med/Surg floor. However, got a doctor in the community who started doing Insulin drips in the Urgent Care at the local Clinic. Now that was scary!

I have done Heparin drips and Caffeine drips on the postpartum floor. Caffeine drips work great for spinal headaches.