Do you titrate drips?

VANurse2010 · May 18, 2015

Ive started to wonder out of curiosity (because I've only worked in one hospital system)... how many hospitals have nurses titrate cardiac drips? It wasn't anything I was taught in school and even at my job I hear rumors that lots of hospitals don't do it.
Basically on my floor (stepdown) it's very typical to have a patient on a cardiac drip like dopamine, levophed, cardizem, lidocaine etc... and we'll be given parameters to maintain such and such map or sbp. Meaning I adjust dosing based on my judgement.
So my question is, do you do this where you work as an rn?

Drip titration is a mainstay of critical care nursing. Stepdown - depends on the facility and the ratio. I've never heard of Levo being allowed on stepdowns at all.

LittleRedOwl, ADN, ASN, BSN, RN · May 18, 2015

Levophed was specifically one I heard coworkers saying they couldn't do at other facilities. Just yesterday I had a patient on dopamine and levophed.

kiszi, RN · May 18, 2015

What are your ratios? I work in a small ICU where we commonly titrate sedatives such as propofol and versed, as well as vasoactives such as cardizem and labetalol. The pressors aren't used as frequently here, but we do get them on occasion. Once a patient gets to the point of needing multiple pressors, they are usually sent out.

blondy2061h, MSN, RN · May 18, 2015

Drip titration is a mainstay of critical care nursing. Stepdown - depends on the facility and the ratio. I've never heard of Levo being allowed on stepdowns at all.

Every step down unit in my hospital can do Levophed now. It only recently became that way. It used to be reserved for the purely critical care areas. Now it's recommended as a first line pressor in sepsis, hence the broadening of use. No more "Levophed, then you're dead."

VANurse2010 · May 18, 2015

Every step down unit in my hospital can do Levophed now. It only recently became that way. It used to be reserved for the purely critical care areas. Now it's recommended as a first line pressor in sepsis, hence the broadening of use. No more "Levophed, then you're dead."

I guess my issue with Levo outside the ICU is - are the ratios appropriate (really should be no more than 3). Do you have dose limits (say

Lev, MSN, RN, NP · May 18, 2015

Yes in the ER we can titrate everything ICU can.

FloatRN19 · May 18, 2015

At my hospital titration is encouraged as well as just shutting off the gtt to see if they can tolerate being off of it. At least that's how I've been taught, practiced and haven't been reprimanded for.

Im not sure if I've had them on stepdown/progressive/pins but I've obviously had them on cardiac and in the icu.

blondy2061h, MSN, RN · May 18, 2015

I guess my issue with Levo outside the ICU is - are the ratios appropriate (really should be no more than 3). Do you have dose limits (say
Most of our patients have some sort of central access regardless. We have a 24/7 infensivist who can place CVL's whenever needed. Any nurse can assist with that, as it's just a matter of gathering supplies. We have a dedicated line placement cart that we can grab that has everything on it. Then, after the patient is stable, we can worry about restocking it.
No dose limit on the Levophed. Max of two pressors outside of ICU. ICU is notified when a second pressor is started so they can prepare for a transfer if needed. There is always an open rapid/code bed in ICU if we need to move the patient energently.

LittleRedOwl, ADN, ASN, BSN, RN · May 18, 2015

1:3-4 ratio on my floor. And you can have a couple drip patients at times.

We titrate based of a range of limits on a badge card we wear behind our badge.

dirtyhippiegirl, BSN, RN · May 18, 2015

Just another way that hospitals are cutting nursing costs. You need half as many nurses now! But the patients are just as sick! Yuck.

melizerd, ASN, RN · May 18, 2015

We titrate cardizem but I haven't seen the others and I've been here a year. Days have 3-4 patients and we'd give that nurse only 3.

We are technically oncology med/surg but we are the icu step down as well.