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Discussion

Drips

I’m starting out as a new grad in the PICU, and would like some advice/tips on how to draw up drips in an emergency situation

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    I don't work in PICU, but I am procrastinating on doing my homework so... what drips? I would hope that your unit would be pre-stocked with the most common gtts in the correct concentrations. This is important because not every medicine is 1mg/1mL. If you use an IV pump that has a drug library loaded into it (like Alaris Guardrails) then it will only have library entries for your standard concentrations. Example: Leovophed (norepinephrine) is 8mg in a 250mL bad...and is commonly dosed in mcg/minute (maybe mcg/kg/min for peds...can anyone confirm?) Either way, you *really* want to be using the correct concentration *and* using all available safety measures before starting a gtt like that, especially in an urgent situation. In the event that you need to mix a bag of something on the unit (like dilute a vial in a bag) you really need a reference (either a list of your standard concentrations, or call the pharmacy for help).

    For true "code blue" meds I don't think of these as "drips" (and I'm not trying to quibble about your word choice, it's just that most code meds are given by IV push). Your frontline drugs should be in a code cart...stuff like epi, amiodarone, narcan, D50, etc... (Our hospital puts much more than "just ACLS drugs" in these carts, but every hospital is different! Our code teams carry intubation drug kits, but these are not in our carts.) For peds I understand that most of these drugs are weight-based, so your unit should have a protocol for how you know the right dose of each drug for each patient. (Our EMR lets us print an emergency med sheet for patients with these doses, since sometimes we have tiny adults who are less than 40kg.) Your orientation should include some code blue drills so that you have a bit of an idea where to find the drugs in the cart. Some drugs will be in preloaded syringes (Bristojet is one name) where you have to remove the caps and screw in the plunger...get your hands on one for practice, because they're not completely self-explanatory in an emergency!

    Does any of that help?

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    Generally speaking, new nurses in most PICUs aren't the ones drawing up drugs or mixing infusions in emergent situations. That role is usually assigned to someone from the code team or to the resource nurse. As the new nurse, you'd be more likely assigned tasks more suited to your inexperience, such as collecting equipment and supplies, doing CPR, documenting and that sort of thing. Always remember you're part of a team; you're not going to be the only one at the bedside for more than a brief moment when something goes pear-shaped. Another point I should make is that it's up to you to know and communicate your limitations. For example, I have arthritis in both wrists and have torn a rotator cuff, so I know I won't be able to provide effective compressions for very long. (Recertifying BLS annually is about as good as I get... you know, the 3 or 5 rounds of compressions and then you're done.) If your hands shake when you're in the throes of an epi rush, drawing up drugs might not be your best role, even after 10 years! I dropped an amp of bicarb, smashing it all over the floor, in a code years ago and it still lives in my mental movie file. I'm not easily rattled, but that did it.

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