Beta Blockers

[Kooky Korky, BSN, RN]

What do you usually see as the pulse rate below which you hold a BB? What setting are you in?

Thanks!

[LPNweezy]

a pulse below 60 i would hold. the normal limit is 60-90. i would feel kinda fishy about giving it at 62 or 63 personally, its more of a judgement call if there are no parameters on the order. and there are 99% of the time, parameters. LTC

[canchaser, BSN, RN]

Agree with prev poster. Cardiac Icu

[VioletKaliLPN, LPN]

i am a student in a practical nursing program(lpn), and we are taught to hold at 60 beats or less, but our teacher mentioned that 62 or 63 was not on her comfort level.

[gigglymo]

Technically 60, in CCU - but it depends on where the patient has been trending on previous nights.

[psu_213, BSN, RN]

Many times the physician's order will come with HR (below 50, 55, 60 are the most common) and BP (such as systolic below 100) parameters for beta blockers.

[ExPharmaGirl, BSN, RN]

I'm a nursing student. BUT. I also took a beta blocker for a period of time for palps. My cardiologist told me to hold for myself if under 50. My HR is low to begin with (~60 to 65) and BP is usually 90/60.

In my clinicals I always see the orders in the hospital to hold if

[rkitty198, BSN, RN]

In all of the drug guides I have read they say 60 bpm, hold if less than 60- I have never seen an order for give if HR in the 50's I work Surg/Onc now. I don't remember seeing in Tele to give if HR in the 50's, but there are probably always extenuating factors to give it if HR is in that range.

[Forever Sunshine, ASN, RN]

If its below 60 we hold it. But I've seen some parameters at below 50.

[MunoRN, RN]

It's important to take into consideration more than just the current HR. If the patient is on a continuously acting beta blocker, and their HR is 58 prior to the next dose, their HR shouldn't really change significantly since the HR of 58 is with the beta blocker already working (from the previous dose). If it's their first dose ever, then you'd respond differently since you would expect their HR to change. If they aren't symptomatic in the 50's then giving the next dose isn't a problem.

The lowest parameter I've seen was 45, the patient tolerated a HR of 45 just fine, and they were in and out of A-fib with a rate of 120+ when they were in A-fib, then back down to the 50's in SR, so you need enough beta blocker on board to control the A-fib without being symptomatic in SB. This patient was waiting for a pacemaker, since then you can increase the beta blocker and not worry about how slow they go in when in sinus.

[NurseStephRN]

Depends. I've had an electrophysiologist write a parameter to hold the beta blocker for HR

I also think about the dosage of the beta blocker. Some of my open heart patients have orders for 12.5 mg Lopressor, which most of the time doesn't lower their BP too much (or their heart rate). Now, if it the order was 100 mg Lopressor and their HR was 63, I'd probably hold the medication until their HR perked up a bit.

[kla374]

I always check the trend of the HR before giving a beta blocker if it's on the low side. If it has been consistent I'll usually give it. At my hospital we aren't allowed to use our own judgment and hold any medication. 90% of the time there is no parameters either. So we make a lot of phone calls.