I have a question about giving a NTG bolus. I was asked to give a patient a 12.5 mcg bolus of NTG and then start the drip. I was unsure of how to do that. I read in my IV drug book that the AHA guidelines for Unstable Angina/MI to give 12.5-25 mcg bolus of NTG and start a drip at 10- 20 mcg/min. It does not specify exactly how fast to give the bolus. I was reluctant to give a bolus given that I have always just started a drip at 5-10mcg and titrated the drip to effect. The patient was having unstable angina and was not actively infarcting, he had been given a SL spray of NTG, MSO4 2mg and Ativan 1 mg witha resolution of symptoms. I told the physician that I was not comfortable giving him a bolus because I didn't have proper guidelines, and that I would start the drip at 10 mcg/min and titrate accordingly. He accepted this, but was curious as to why I would not give the bolus. Any insight in this issue would be greatly appreciated.
Apr 7, '02
would clarify specifically with doc
use pharmacy as resource
use fellow more experienced nurses
Last edit by micro on Apr 7, '02
Apr 7, '02
WOW! I have never given NTG as a bolus. They are really doing things differently since I went into HH. I have seen NTG boluses given accidentally (Like when a drip was D/C'd and a new nurse flushed the line) and watched BP plummet rapidly, so I personally am with you, I would be uncomfortable with the idea.