calcium chloride

Jaelle625 · Mar 20, 2013

We give CaCl regularly on our unit in response to hypotension. Your serum Ca may be normal, but your Ionized Calcium (free floating, available to be used Ca) may be low. MD is correct in that it improves contractility and therefore BP. It's the policy at my facility that it only be administered via central line because of its vesicant properties. Serious Kudos to you for researching before administering!

22gawhitacre · Mar 20, 2013

I hope you were giving it through a central line and not peripherally.

ckh23, BSN, RN · Mar 21, 2013

Hi everyone I am a nurse in pacu at a large hospital I have 7 yrs ICU experience had a patient post femoral endarectomy with history of 3 mi's and 8 stents. Also history of vtach and bradycardia post surgery he became hypotensive so I started neo gave albumin and hespan with improvement in bp. Ebl was 550 so we drew hgb and it had dropped 4 grams. So of course we would transfuse when blood ready. Anesthesia md wanted a gram of calcium chloride iv and since I had only given in code situations I wanted to make sure it was safe..called pharmacy. Verified with me 3 times (he was not happy I questioned his order) i asked him to explain the reason and mechanism behind this met in this specific situation. I do not give anything without knowing why. He said to increase bp and contractility. Everything I looked up points to it causing hypotension when giving I've and helps contractility only in code situations non responsive to epi. Calcium level was 9.7 already and if I understand right it causes k to lower when given increasing arrhythmia risks. The explanation didn't make me happy or help me understand so just wondering if anyone else has ever given for the reasons stated by md? I just want to understand!!!

You have to go into the physiology of the smooth muscle and the heart to find out why Ca will improve contractility and help increase BP. In a nutshell it will help raise intracellular Ca which will help the smooth and cardiac muscle contract thus increasing contractility and raising BP.

allnurses Guide · Mar 24, 2013

In addition, if you're going to give a bunch of blood transfusions, the citrate in the packed cells binds to ionized calcium and calcium is an essential component of the coagulation cascade. Anesthetists in the OR give calcium often in cardiac surgery patients.

ccampbell66 · Apr 8, 2013

ghillbert, are you Australian? If so I would like to talk to you about a topic unrelated to this. Thanks. Carter

allnurses Guide · Apr 27, 2013

Yep I am :) You can message me.

Bec7074 · May 5, 2013

CaCl is also a buffer for acidosis if that's what they think part of the problem was. It's a typical part of the "high K" cocktail that coincides with acidosis. I had a patient so acidosis/hypotensive once that her pressure would bottom out the second the CaCl finished infusing (we use IVPB unless in codes).