Ativan, insulin, alcohol drips on floors? - page 2

For those of you who work in med-surg, do you do ativan, insulin, or alcohol continuous infusions on your floor? If so, how do you handle the frequency of the vitals you need to do, as well as... Read More

  1. by   debbyed
    Rule of thumb at our facility is that if the patient will require vital signs or other treatments (ie: Blood sugars) more frequently that q1hr they got to ICU. If more frequently than q4 hour they go to PCU, otherwise they go to the floor.
  2. by   susanmary
    Love this bulletin board -- get the best advise from some great nurses. There's lots of experience and great insight from you guys. Thanks. Just wondering if you do continuous IV drips on the floor, the SICU, the ICU? How frequent the vitals?

    Love the idea of the caffeine drip -- I could use one right now. Actually, I'm sipping some amaretto cream coffee -- for those of you who LOVE coffee -- this one would make you weep!!!!
    Last edit by susanmary on May 20, '02
  3. by   thisnurse
    on our med surg floor we frequently have insulin drips with 1 hour accuchecks.
    never heard of caffeine, etoh, or ativan drips.
    what will they think of next
  4. by   hapeewendy
    the floor I work on has many insulin and heparin drips, no alcohol drips and no ativan to be given
    IV - we just ran into a case where the MD kept ordering ativan via IV, despite being informed that we cannot provide that service on our floor
    finally everytime she wrote it we called her to come and give it IV push, needless to say the next day the order read , Ativan PO/SL
    that'll learn ya
  5. by   MHN
    Susanmary,I have seen IV insulin infusions post -op but only for insulin dependent diabetics.Rate dependent on bgls. regular 1/24 bgls + 4/24 obs
    When I did my Midwifery training IV absolute alcohol infussions used as way of delaying premature labour ,but that was in the "ark".so I can't remember for sure obs required ? B.P. Pulse and Foetal heart rate.:imbar
    Last edit by MHN on Apr 6, '02
  6. by   lgcv
    We routinely used Ativan and Insulin drips in the ICU I used to work in. We only used alcohol drips (+alcohol dialysis) on patients who had injested antifreeze. Insulin drips were sometimes used on the floors, but they usually moved them to the unit due to the time intensity involved with q 1 hour blood sugars. My opinion is that if you put someone on the floor with an Ativan or alcohol drip you would be asking for trouble. I know that continous pulse oximetry etc.. are required for sedative drips an impossible feat on a stepdown floor. Just look at the monitoring requirements in a drug book then ask them to explain how you are supposed to do it.
  7. by   mattsmom81
    Very interesting responses in this thread.

    My personal opinion is titrated drips or narcotic drips don't belong on medsurg unless it's a morphine drip on a DNR. Anyone with hourly fingersticks and insulin drip adjustments should be on a monitored PCU floor, no greater than 1:4 nurse patient ratio. IMO. I know...this isn't our reality but it SHOULD be...LOL!Stepdowns/PCU's should have a central monitor capable of displaying vitals and pulse ox as well as cardiac rhythm....

    I like Debbye's policy with frequency of vitals helping determine where a patient should go ie PCU or ICU. That gets everyone on the same page when considering acuity.

    Patient acuities on medsurg are sky high these days..what i see in medsurg would have gone to ICU 25 years ago......I honestly don't know how these nurses can cope.

    One hospital near me teams a nurse with her own PCA (who can do fingersticks, foleys, NG's, vitals etc) and it seems to work well. They take a team of 7 or 8 and split the work...nurse legally must do asessments, meds, charting. I know UAP's are a hot button now but it's been helpful to have them in many situations I've seen.
  8. by   pebbles
    I still can't believe nurses are expected to safely titrate the "drips" of these serious medications by hand with a roller clamp. Hey, this is not the dark ages any more - get on somebody's case at your facility that it is much safer to have an infusion pump. (syringe or iv bag, whatever) They want you to take five, six other patients, some of them also with drips - they should facilitate safer use of these *potentially* dangerous drug infusions.

    *reduce* the risk, improve safety, before something really bad happens. Makes work life much less stressful for the nurses too, helps keep you well staffed, etc. Benefits everywhere for the cost of an infusion pump.
  9. by   susanmary
    Last edit by susanmary on Aug 30, '03
  10. by   pebbles
    Thanks, Susanmary... I wondered.

    This brings the question of frequency of vitals (and blood glucose checks) as well. How often do we really need to do them for it to be safe? Somebody said q1h blood sugar checks, and I thought "no wonder some nurses are run off their feet!"

    I don't know offhand any studies done that show how often these tasks need to be done to ensure safe and adequate patient care - but it is worth thinking about. I think we place too much importance on the numbered data (BS, Vitals), because it is easier to write in a chart. That way, it is documented that the patient was okay at 1430, or whatever. But I really think we over-vital people.
  11. by   shannonRN
    i work on a med-surg floor and we have patient on insulin, heparin, and sometimes dobutamine drips. staffing on days is 1:4 or 1:5, evenings 1:5 or 1:6, and midnights they start at 6 and can have up to 11!!!!
  12. by   susanmary
    Last edit by susanmary on Aug 30, '03
  13. by   gpip
    we use insulin and ativan gtt routionely in ICU. Insulin with sliding scale however the scale is written Q1-4 hrs. Ativan gtt for sedation of some ventilated patients if they are too restless or are paralized. I have seen 1 alcohol gtt a few years ago as a way to easy ETOH'er through severe DT's. vitals on the unit are standard Q1 hr. Check sedation Q2-4 Hrs using ramsey scale. standard policy in our facility is all medication infusions must be on IVAC's.
    Last edit by gpip on Apr 9, '02