hanging cartizem

Nurses General Nursing

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My procedure book states cartizem needs to be hung as a piggyback at the closest port to the pt and on a pump. Can someone explain this to me?

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Specializes in Rural Health.

I'm assuming you mean Cardizem......

A pump because it's a pretty dangerous drug to main line into your patient without some control. You also have to be able to regulate it (titrate it) according to heart rate and blood pressures.

Closest port cause the drug needs to actually reach the patient and not sit in the tubing. It's nothing to run Cardizem a fairly slow rate once the heart rate is controlled. Your primary IV line ideally should be on a pump as well so you aren't bolusing your patient with Cardizem.

I hope that helps.

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Specializes in Cardiac.

I do not run Cardizem as an IVPB.

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Specializes in Rural Health.
I do not run Cardizem as an IVPB.

Really, how come? It was our policy to be ran as IVPB in the ER but I really have no clue why so I'm very curious.

We rarely ran it for long in the ER, usually a couple boluses fixed the problem and if we did put it on them as a rate control it usually wasn't for too long.

Thanks!!!!

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Specializes in Cardiac.

We just run it as a straight drip.

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Specializes in ER/ICU, CCL, EP.

I will run cardizem with regular IVF, or NS at 20ml, at the closest port to the patient, and on its own pump. My reasoning is that when you titrate it down, you can get to low flow and clot off the line. I think the clotting thing is especially problematic when running it through a PICC. A peripheral can stand the low flow a little better, IMHO.

However, I never think that ANYONE that runs something as sensitive as cardizem by itself is wrong. :)

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Specializes in Cardiac.

However, I never think that ANYONE that runs something as sensitive as cardizem by itself is wrong. :)

I'm sorry, I assumed it was inferred that I would run it with a saline kicker. I said I don't run it as an IVPB. Big difference.

For the record, Levophed is 'sensitive' and I run it by itself (along with a slew of other 'sensitive' meds.)

And, it's not wrong.

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Over the last few years, most of my patients had cardizem going fast enough to prevent clotting and the docs in that area did not want extra fluid going anyway.

Different hospitals and different areas of states and the country tend to have different protocols depending on the docs preferences. It is not unheard of for docs in one location to all use similar protocols and orders.

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My hospital is stingy with pumps. Cardizem is always on a pump, but the NS can't be.

How does this sound? Bag of NS hooked straight up to pt going at 10-20cc/hr. Cardizem on pump hooked up to NS IV tubing at port nearest to pt.

Does it make a difference which tubing is hooked up to the pt? In other words, would there be a problem with hooking the Cardizem tubing directly to the pt and then connecting the NS tubing to the nearest port of the pt? I've seen it done both ways.

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Specializes in ER/ICU, CCL, EP.
I'm sorry, I assumed it was inferred that I would run it with a saline kicker. I said I don't run it as an IVPB. Big difference.

For the record, Levophed is 'sensitive' and I run it by itself (along with a slew of other 'sensitive' meds.)

And, it's not wrong.

Erm, I was agreeing with you. Sorry if you were offended, or if I was unclear. My statement was, that i would never assume that someone who ran a cardizem drip as a drip by itself was 'wrong'.

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Specializes in Utilization Management.
My hospital is stingy with pumps. Cardizem is always on a pump, but the NS can't be.

How does this sound? Bag of NS hooked straight up to pt going at 10-20cc/hr. Cardizem on pump hooked up to NS IV tubing at port nearest to pt.

Does it make a difference which tubing is hooked up to the pt? In other words, would there be a problem with hooking the Cardizem tubing directly to the pt and then connecting the NS tubing to the nearest port of the pt? I've seen it done both ways.

I always put the Cardizem on the pump on a primary line and hook the IVF's into the closest port with another primary line on a gravity drip.

It's one of those things that sounds more complicated than it actually is, if you know what I mean.

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To all unfamiliar with Cardizem infusions:

Your hospital pharmacy should have a protocol for Cardizem (Diltiazem) Infusions. Generally they contain the following items:

  • Pt must be on a cardiac monitor
  • Frequent blood pressure monitoring
  • Maximum infusion rates (usually 15-20mg/hour)
  • Pt should be in a critical care area (ER, ICU/CCU or step-down unit where staff are ACLS trained.

The physician will usually order a bolus (usually around 10 mg IV) followed by a beginning infusion rate with titratable parameters for HR and B/P. Some patients are very sensitive to Cardizem and will rapidly drop their HR and B/P. You want to be able to stop the infusion ASAP if this happens. Therefore, it is not a good idea to run Cardizem as your main line with the saline piggybacked into the Cardizem. Do it the other way around.

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