easy way to remember drips...

[SheriLynnRN]

I was just wondering of any of you long timers had any memory tricks or ways to help remember which drips do what and/or what doses to start at...whether they are in mcg/kg/min or mcg/min etc.

Or does it all just come with practice? Once I look the drips up, I have no trouble understanding what they do...just looking for a way to not feel like I'm fumbling for the action of each drug..

Also, are there any good resource sites out there? I've done the PACEP site...and I think ICUFAQ.com/org is down.....

TIA!

[anurseuk]

Well as a quickie your inotropes will generally be in mcg/kg/min, the dose should be on the prescription and generally with inotopes you will use as much as you need to obtain the aimed for BP. Usually in critical care the dr's will put a ceiling on the max dose of inotropes to give individual pt's.

I think it's something you pick up as you go along and as you become more familiar with the drugs. Also on your unit there will be certain drugs you'll use a lot of and others you will barely see.

Insulin - units/hr

heparin - units/hr

noradreanaline, adrenaline, dopamine etc - mcg/kg/min

morphine - mg/hr

....could go on and on... prehaps as you come accross the different drugs in your unit jot down on a note pad what is what and then you can refer back to it and eventually wont need to at all....

hope that helps :)

[ghillbert, MSN, NP]

Looks up every drug, every time you use it. Link the action to what is wrong with your patient - helps me to remember why we're using it clinically, rather than just the book info. Eventually, it comes naturally but a lot of it is repetition and memorization.

[joeyzstj, LPN]

I carry a Tarascon Pharmacopia (sp?) book. Most of it just comes by using the drips over and over each day.

[meandragonbrett]

noradreanaline, adrenaline, dopamine etc - mcg/kg/min

)

Not all facilities use weight based epi and levophed. Many use mcg/min.

[MissAnthrope]

One trick I learned in nursing school is for Dobutamine and Dopamine. They're fairly easy to get confused the first few times. In fact I still hear nurses sometimes having to remind themselves of the difference.

DoButamine works on the Beat (of the heart, obviously - so best for weak pump diseases), and DoPamine works on the Pressure (meaning BP - best for raising blood pressure).

And there's the old adage "Levophed or Leave 'em dead", signifying the seriousness of Levophed and the fact that is often one of those hard hitting, last hope drugs to maintain essential circulation. I've also heard "Levophed, heart and head" which someone told me they used to remember that due to the massive systemic vasoconstriction caused by Levo, peripheral circ. will suffer so that the core organs can get what they need (in this case, heart and head being two), so checking periph. pulses and extremities is a priority and its not uncommon to see that scary purple color and mottling sometimes in their hands and feet.

Another one I learned in my current travel assignment that I didn't know before was that if you have a hypotensive patient on Dopamine, and you're not getting the results you need and have to switch to Levo, it's best to start the Levo while the Dopamine's still running and then titrate your Levo up while you titrate the Dopamine down. Stopping Dopamine can sometimes cause a further rebound in hypotension, so the Levo acts as your backup.

That's all I can think of right now. Hope that helps in some way.

[anurseuk]

One trick I learned in nursing school is for Dobutamine and Dopamine. They're fairly easy to get confused the first few times. In fact I still hear nurses sometimes having to remind themselves of the difference.

DoButamine works on the Beat (of the heart, obviously - so best for weak pump diseases), and DoPamine works on the Pressure (meaning BP - best for raising blood pressure).

And there's the old adage "Levophed or Leave 'em dead", signifying the seriousness of Levophed and the fact that is often one of those hard hitting, last hope drugs to maintain essential circulation. I've also heard "Levophed, heart and head" which someone told me they used to remember that due to the massive systemic vasoconstriction caused by Levo, peripheral circ. will suffer so that the core organs can get what they need (in this case, heart and head being two), so checking periph. pulses and extremities is a priority and its not uncommon to see that scary purple color and mottling sometimes in their hands and feet.

Another one I learned in my current travel assignment that I didn't know before was that if you have a hypotensive patient on Dopamine, and you're not getting the results you need and have to switch to Levo, it's best to start the Levo while the Dopamine's still running and then titrate your Levo up while you titrate the Dopamine down. Stopping Dopamine can sometimes cause a further rebound in hypotension, so the Levo acts as your backup.

That's all I can think of right now. Hope that helps in some way.

As a rule you would always wean your inotropes down and never just stop. I find that Dopamine isn't that great with hypotensive patients and noradreanaline is much more effective... and we use it as a first line vassopressor. But with all inotropes you should be checking pulses regularly:D

[SheriLynnRN]

DoButamine works on the Beat (of the heart, obviously - so best for weak pump diseases), and DoPamine works on the Pressure (meaning BP - best for raising blood pressure).

That's exactly the type of memory aid I was thinking of! Thanks!

[MissAnthrope]

Of course, DoPamine also works on the Pee as well...you can run what's called "renal-dose" Dopamine at a low rate which is in theory supposed to improve circulation to the kidneys...but I see this being used less and less and had a nephrologist tell me it doesn't really work very well.

[anurseuk]

Of course, DoPamine also works on the Pee as well...you can run what's called "renal-dose" Dopamine at a low rate which is in theory supposed to improve circulation to the kidneys...but I see this being used less and less and had a nephrologist tell me it doesn't really work very well.

The use of a renal dose is quite controversal, research actually shows that it doesn't improve urine output; it does increase CO and pressures etc which would perfuse the kidneys which is why the urine output would be better... but I was told last night its renal toxic.... saying that, yes it is still quite commonly used for this reason.

[MissAnthrope]

As a side note, it should go without saying that ANY time you're running an antihypertensive drip (Nitroprusside, Nicardipine, etc.) please take their BP down s...l...o...w...l...y!

Had an issue with that recently at work.

[MaryAnn_RN]

I have a little book which is indexed A-Z and which fits nicely into scrub pockets - any address type book would do. As you come across drugs for the first time, make an entry on the relevant page with brief details for that drug. For example:

Drug name

Dilutent

Strength per ml (ie Noradrenaline = 80mcg/ml at single strength)

Action of the drug

Side effects

Anything else that might be relevant