natrecor drips

  1. i am hoping everyone will come to my aid again. you guys are great resources!! last night i had a patient who was to be started on a natrecor drip. i work med-surg and haven't heard of one of these drips before. i called the coordinator/supervisor and she said she didn't know much, pharmacy couldn't find the policy and procedure, and the doc thought we were perfectly capable of monitoring her on our floor but gave me the okay for transfer. we were finally able to convince the coordinator to give us an imcu bed for this patient.
    so i guess my question would be, what is everyone else's policy and procedure. and any info you would be willing to share on this drug would be appreciated.
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    About shannonRN

    Joined: Oct '01; Posts: 523; Likes: 37
    onc/heme rn


  3. by   Zee_RN
    Natrecor is a relatively new drug used for patients with acutely decompensated CHF. It is adminstered IV. Because it can cause hypotension, I would hope it would be administered in a critical care unit. I don't know that my facility has a policy on Natrecor yet; I haven't seen it ordered. The goal of Natrecor is to redue pulmonary capillary wedge pressure and improve dyspnea.

    It should be noted that Natrecor is NOT compatible with heparin or lasix, along with several other drugs. Natrecor binds with heparin. Do not use heparin-coated catheters.

    For more information:
  4. by   thisnurse
    thanks for the info....something im sure ill be running into before long
  5. by   indeed
    The hospital I work at just added Natrecor to the formulary and as far as I know, it hasn't actually been used yet. I can't really add much more to Zee_RN's description, other than we were told that when the drug was in testing, they never hung it with Tridil (because of the hypotensive effect again). If you can get a hold of one, the drug rep gave us a slew of these dosing cards that have all the info on them...they are very useful (we have them for many of the more complicated drips we hang). Not sure if there is a policy on it, but my guess is it will stay in the unit. Hope that helps.

  6. by   fedupnurse
    We have used it a couple of times and are formulating a policy on its' use. This is NOT a drug to be used outside of the ICU environment! Ideally, the patient should have a Swan Ganz catheter and adjustments are apparently made based on the Swan readings. We also don't allow Dobutamine on the floors unless it is long term and not being titrated. How on earth can you closely monitor a patient on a drip like this on a med surg floor? You guys have way to high a nurse to patient ratio already! Even tele in our place has too high a ratio to do intensive monitoring. I'm working tonight, I'll check and see if we have a policy yet and let you know.
  7. by   moonshadeau
    interesting. When the drug reps came to my tele floor, that is all they said is that you could still have a patient on this drip and still carry a load of six patients. Typically, if we can stand it we try to avoid all drips. Not always really lucky though.
  8. by   Rustyhammer
    If the drug reps were right we wouldn't have to hardley do any work at all. Just give their meds and life will take care of itself.
    Oh how happy we will all be.
  9. by   fedupnurse
    Shannon I have the policy for my facility in front of me. Among other things it says it must be administered by an RN who has recd. instruction on the proper administration and monitoring of cardiac drugs, blah,blah,blah... Goes onto say about vs q 15 min x 1hr, q 30mins x 1 hr, q 1 hr x 2 hrs then q 4 for the duration of the infusion (we do q 1 hr in the unit on this type of drug). After 3 hrs, if there aren't significant relief of symptoms and/or increased cardiac output (Swan Ganz is the best method for this) rebolus and then check again 6 hour later.
    Clearly, this is a patient that needs to be in an ICU setting. On Tele or med surg you simply do not have the time and in some cases the equipment to accurately monitor these patients. Our policy has some leeway because we have an outpatient CHF unit and I think the doc that wrote the policy had an eye toward possible use on that unit. The end of the policy states that those who do not show improvement after the 48 hour dose should be considered for invasive hemodynamic monitoring. The rep here told us they should already have a Swan in place.
    Guess it depends on the part of the country you are in, or perhaps the drug reps check with the hospital first to see where the patients will go.
    If you want more info about our policy PM me.
    See ya,
  10. by   JeannieM
    This is interesting. Actually, we are administering nesiritide (Natrecor) both on the Telemetry floor and in the ER, as well as the ICU. The blood pressure can and does sometimes drop (hence the q 15 minute vitals) but usually resolves with turning the drip off (we've seen this a few times). We've seen some wonderful success stories with this drug; patients who were able to resolve and avoid an ICU stay, great turn-arounds in the ER, etc. Unfortunately, we've also seen some patients who weren't helped, so this drug doesn't work for everyone. You should be seeing a resolution of symptoms and a diuresis with the first 2-3 hours (usually it's sooner). Good luck! Jeannie
  11. by   JeannieM
    Oh, and here's a website to provide more information. Jeannnie
  12. by   Zee_RN
    Well, I guess my facility has a policy on it; I heard a patient in the Unit today was on Natrecor and Nitro...I was surprised that he was on both since natrecor can drop pressure. And they have not done clinical trials on individuals with both natrecor and tridil (according to the dosage card I have in front of me). But I just heard about this at the end of the day so I didn't have time to investigate. Will check tomorrow if it is less hectic (one of our nurses had severe asthma attack at work and had to go home so things got nasty as we picked up extra patients).
  13. by   shannonRN
    thanks for the replies. as always you guys are wonderful! :kiss the info will come in handy when i return to work. hopefully i can get my hands on a copy of that policy. glad to have all of your reassurance that i did the right thing by insisting that this patient was transfered. i wish we had inservice on everything we give...part of the reason i don't plan on staying too long. thanks again!!
  14. by   jentenrn
    When using the natrecor it is a weight based protocol. Our emergency department has started to use ti more frequently and we are now able to order it from the pharmacy by simply writing "Natrecor gtt and bolus per protocol" and then the pt's weight. You give the bolus and then start the drip and there is no titration neccessary as with a nitro drip. The literature states that there should be a nearly immediate response in patients respiratory status but I have yet to see it happen inside of an hour or two and generally by that time they are in the ICU. I am unable to speak for the long term use of the product since I work in the ER. I can say that in the time it takes for the ER MD and PMD to decide to use the drug, the time it takes for pharmacy to prepare it and then to administer it, the short term effects are no different from that Lasix and nitro gtt combination.