Common Drips Used in CCU

Specialties CCU

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I was just wondering what are some common drips used in CVICU especially for patients that have undergone a CABG, MVR, AAA, or have a MI

Thank you

Johnny

I have been reading about Neo-synephrine and its pure alpha effects and that it does not effect the heart rate. In what circumstances have you seen it used? I have been asking at my ICU/CCU and nurses have very little experience with this drug. Are you using it in place of Levophed? Any response would be appreciated. Thanks

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Specializes in ICU, tele.

We use Neosynephrine as a first line drug to keep MAP between 70-80mmHg. We have standing orders on fresh post op valves and CABG's to use it up to 100mcg before we call the MD. We try not to use Levophed because of the effects it has on the other organs. We've had patients on high dose levophed and 2 or 3 days latter they have ischemic bowel.

Our cardiothoracic MD's like to keep their valves dry, so we hardly can ever get orders for fluid. It's neo, neo, neo.

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I've found that ggts depend on your MDA. Or is it the area of the country? Up north I remember lots of Dop, Dob, Nipride, Propofol and Hespan. Down south seems to be Epi, Neo, Milrinone, NTG, and Albumin for volume.

We use a lot of hextend as well as Albumin. I would wager their uses are more dependant on physician than region. Same with pressors. One ct surgeon loves dobutamine, and rarely uses dopamine. Another is totally opposite.

The neo is just a pure alpha, while levo has added beta effects and nasty side effects

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Controversial as it may be, my CCU uses gallons of Natrecor in lieu of Primacor. Supposed to be easier on the heart? Who knows. Doesn't seem to work as well.

Our CCU docs use Natrecor over Primacor, but the SICU is the opposite. Primacor works wonders in the post op CABs when indicated because of the increased availability of calcium. If you have a chronic CHF patient, they have been having problems with contractility, and having extra calcium on board to increase the contractility and pumping of the heart would make the heart work harder.

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We use Dob, Dopa, Neo, Nitro, Cardene routinely. For sick hearts, we use vasopressin, epi, and primacor. For volume, we use albumin, and have just started adding hespan d/t nationwide albumin shortage. We only use Levo on septic patients, and it is a miracle drug for them if used early on, and depending on what septic stage the patient is in.

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Our cardiothoracic MD's like to keep their valves dry, so we hardly can ever get orders for fluid. It's neo, neo, neo.

Really? Our surgeons are the exact opposite. Our valves always get higher filling pressures by more volume. What is the thinking behind them wanting dry valves? What do you have for fluids on your standing orders?

Most of ours are okay with Neo, but we have one surgeon in particular who absolutely hates it. You cringe when you have a heart roll out with anesthesia telling you they needed it in the OR, b/c you know you're gonna be up a creek. He'll order low dose dopamine, and you're begging for a SBP of 90 all night.

It's interesting to see how different places treat the same types of patients so differently.

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About half our patients are on an insulin drip post op. Glucose with every blood draw or Q hour.

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Specializes in Critical Care, Psych, Transport.

We use a combination of all the drugs above at any given time depending on the circumstances. All of our pump cases are started on an insulin drip with Q1 hour accuchecks for the first 24 hours and then Q 4. I have to agree with TENNRN2004 about the volume issue. Preop, these guys required higher filling pressures to open the malfunctioning valve and post op we keep the PAD around the same as the cath report showed. We have to in order to maintain a decent stroke volume index and good UOP.

Neo is ok but IMO it is very weak in its Alpha stimulation compared to Epi and Norepi. Almost 90% of the time if you start Neo , go ahead and mix the norepi...you're gonna need it.

Just my 2 cents.

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Specializes in ER, OR, Cardiac ICU.
About half our patients are on an insulin drip post op. Glucose with every blood draw or Q hour.

We are adopting some study (Yale University) that finds better outcomes for patients that have controlled blood glucose; in fact, almost ALL of our patients will be on an insuling drip to titrate sugars to around 70 (I think that was the level- is was far below 100). Just add another drip to the pole, we'll manage ;)

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We use a hyperglycemic protocol for ICU patients. Fingersticks, coverage, and drip, so on..

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I haven't been in the game long, but when a student on the West Coast, I got used to seeing dopamine, dobut, propofol. Now on the East side, I almost primarily see Neo, Vaso, Epi, Milrinone, and Cardene. We start insulin and dex soon after arrival. We have a insulin drip protocol which after 3 q1 hour checks we check q2hours while they are on the drip to maintain glucose 80-110. Tight control as the key. The pt may get to go to Q4 if they have a normal level 4 times in a row, but this is pretty rare. Usually don't get off the drip until they leave our unit.

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