Critical care med drips

[rn1255, BSN, RN]

What is a good book for instructing how to mix critical medication drips, normal parameters for them, etc.??

[smf0903]

Your drug guide should have how to mix and normal doses/parameters (I use Davis and it has them).

We have books made up in our ICU that tells exactly how to mix, what max rate/dose is, special instructions, etc. It's a quick reference for us and exact copies are found everywhere that gtts are administered in our facility (surgery, ICU, etc).

[Okami_CCRN, BSN, RN]

If you are already working in a critical care unit your best bet is to contact the pharmacy for policy and procedure regarding drip concentration and max rates. You will find that many facilities utilize different max rates and concentrations.

At some institutions vasopressin is non-titratable, in others it is. Some places max out norepinephrine at 10mcg/min while others max out at 30mcg/min. While a drug guide can give you great information regarding drug classes, actions, etc you should always follow hospital policy and procedure.

[Steph41]

Some have found the Critical Care Intravenous Infusion Drug Handbook to be helpful. I have not used it. I agree with Okami that your pharmacist is a good resource. Also with multiple pressors on the same pt. It is helpful to consult the intensivist.

If a pt. has epinephrine, norepinephrine, vasopressin, and milrinone - the milrinone is not a pressor but often lower BP while increasing cardiac output. Epinephrine increases pressure and cardiac output but has undesired dysrhythmia effects. So knowing your pt.s cardiac output, CVP, PA pressures, and heart details (Valves,LVED, etc,) and goals is essential. Sometimes the cardiac surgeon or intensivist has a plan so I just ask, which one do you want me to titrate first. If it doesn't mesh with my thoughts I just ask them to educate me as to why and we discuss.