Has anyone used Natrecor on their unit?

[maryangel]

I work in a 33 bed telemetry unit, "stable" tele. The only drips we use are Dobutamine, Heparin, Cardizem. The physicians have decided to use Natrecor to treat CHF instead of Dobutamine. Currently if a patient is on this drip, they have to be in the unit for frequent vital signs, closer monitoring, etc. Our cardiologists want us to give the drip on our floor. Our nurse/pt. ratio is 1:5 or 6 on days and 1:8 or 9 on nights. Has anyone used this drug on their unit? and if so, do you think the ratio we have would be acceptable? Thanks for any input.

[mart18642]

I think this drug should be used in an area of low nurse-patient ratio, and this is the reason why, I have been a nurse for 10 years work in cardiology most of the time, I got this job in a 40 bed tele- med-surge floor one day of orientation to the floor, just this Saturday I took a load of 6 patients one with this drip, another hypovolemic with b/p 85/35 and h/h dropping and the rest with others with high needs. I have to make a decision between my hypo- and the drip, so I figured I start stabilizing the hypovolemic for obvious reasons, infuse RBCs highly needed and monitored very closely for 2 h until I saw she was stabilized and her B/P stable. Finally I went to check on my drip(9:30- no one even check to see why my IV was beeping)when I heard that noise I immediately went to my Pt's room and was his, the Iv was off his hand ( also I had a peripheral line in place) and the drip was totally gone, the rate on that drip was 8 ml/hr , so I thought may be they d/c this drip while I was with this other patient(not clearly thinking yet), then I got call to do some thing else , by the time I was done another call came to see Dr. at the desk and he questioned me why the drip was off this patient, my honest answer was that when I went to check it was already off his arm; this was a big issue with the unit coordinator and got me to the point that I'm putting my 2 wks on Tuesday, this is a delegation issue, I'm new to this floor. Later on I found out that the patient did not want the IV on , so of course he took it off, he which he denied afterwards; I already knew that he had a hx of non-compliance in the chart and the dr confirmed this at his bed side ; I think any critical drip that have to be monitored closely need to be delegated correctly, with less patients, according to acuity. The patient's drip was d/c the very next day and no harm was done to patient, but potential for it, yes...............and the moral and respect for the unit coordinator that runs this unit totally destroyed.

Well I needed to take this incident off my chest

[All_Smiles_RN]

The hospital I was working at was recently considering a move to stop using natrecor as the efficacy is doubtful.

I can't imagine natrecor being used in place of an inotrope like dobutamine.

Studies suggest an increase in mortality associated with natrecor usage. Increased Risk of Mortality with Nesiritide for Decompensated Heart Failure

[Indy, LPN, LVN]

We have one cardiologist out of many who seems to adore using Inocor on his well-compensated CHF patients, and even he doesn't order natrecor very often. It takes me a solid hour devoted to that one patient if they need the drip started, and it's q15 min vitals for an hour or two, q2 hour vitals for the rest of the drip.

We did have one lady who became dependent on natrecor just to breathe. Very sad case, she was 340 pounds, but actually walked on her own some, came in, natrecor gtt, hypotension and hello ICU bed for a while. A few days later they want to transfer her back to tele unit... no problem, we get the room ready and then hear from them that they can't d/c her natrecor drip, every time they try she becomes more unstable, so they kept her in ICU. I didn't hear how she did after that, but it didn't sound like a good prognosis.

We use a wide variety of drips on my unit: heparin, cardizem, amiodarone, inocor, natrecor, integrillin, reopro, (usually integrillin and reopro are hung in cath lab) insulin very rarely, dopamine, dobutamine, primacor, and I can't think of any others at the moment. 1:3-4 on days, night ratio is 1:4-6. It can get pretty hairy even with stable patients to have to start some of these drips. My least favorite would be dopamine because the patients I've had are so darn delicate with what dosage they can take, you get just a half microgram/kg/hr over what they do well with, and there goes your night. Dobutamine has a similar protocol, but I've only seen one bad night with that med, those usually work okay, just very time consuming.

[douglask]

We use Natrecor frequently on our chf patients. We do start on titrate it on our progressive care unit, monitoring vitals q15x4, q30x2, hourly x2, then q four. It is a vasodilator, so the primary thing to watch for is hypotension. It is usually held for SBP

[NotReady4PrimeTime, RN]

We've used it once, about this time last year, on an infant post heart transplant who just wasn't making the grade. There is very limited information on using it in peds, and there I was, expected to run this infusion that I knew nothing about... When I took the patient he'd been on it three days already, and all the information I could gather was clear about it being short-term thing. Being me, I brought that fact up on rounds. Yeah. Shoulda known better. Anyway, we ran it for another 24 hours, and the kid actually turned around. He has been home for eight months and has not made any impromptu visits to our establishment since discharge.

Oddly enough, I won a fully loaded Palm Pilot T/X from Skyscape because some of the information I used to defend my position on rounds came from my copy of Davis Drugs purchased from them. They had an essay contest looking for ways that their products had been useful in the workplace, and this little boy's story was my winner.

[mamason]

Awsome on winning the essay and for being your pt's advocate!