EBP for not holding beta blockers

[CardiacDork, MSN, RN]

I find it quite irritating every time a nurse holds the beta blockers because the blood pressure is low. A night nurse held a metoprolol on a patient that was on a fixed rate CVVHD and had labile MAPs of 58 to 65. Well after so much withholding of the beta blocker the patient went into afib with RVR and SVT. First off if the MAP is labile perhaps you should have called nephrology and asked to reduce the fixed rate just a tad. Allow her pressure to normalize and administered that beta blocker. Also, taking off too much is going to also cause abnormal heart rhythms. All labs were WNL.

Anyway, I've been looking for a good EBP article that has to do with giving/holding beta blockers.

[LongislandRN23]

All meds especially cardiac related should have clear and concise parameters in the orders. I always clarify with MDs if orders do not indicate parameters for bp/hr

[nutella, MSN, RN]

I find it quite irritating every time a nurse holds the beta blockers because the blood pressure is low. A night nurse held a metoprolol on a patient that was on a fixed rate CVVHD and had labile MAPs of 58 to 65. Well after so much withholding of the beta blocker the patient went into afib with RVR and SVT. First off if the MAP is labile perhaps you should have called nephrology and asked to reduce the fixed rate just a tad. Allow her pressure to normalize and administered that beta blocker. Also, taking off too much is going to also cause abnormal heart rhythms. All labs were WNL.

Anyway, I've been looking for a good EBP article that has to do with giving/holding beta blockers.

yeah - this is a common dilemma... and often accompanied by a poor understanding of CRRT as well as heart rate control.

[ghillbert, MSN, NP]

Should be specified in the order - we usually write "hold for SBP