hanging cartizem

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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?

Specializes in ICU/CCU, Home Health/Hospice, Cath Lab,.

The only problem I can see with running a gravity infusion of NS into cardizem, versus the cardizem running into the NS - is if someone accidently hits the roller clamp (such as your patient) then you could accidently bolus whatever is from the port to the IV.

Now granted that would not be much - but if the HR was already going slower then that quick bolus might really drop it.

However, if the cardizem is running into the saline and someone accidently loosens the clamp the bolus effect should be much smaller (cardizem usually runs around 5-10 ml/hr while TKO NS from 20-40).

This is the main danger of running a pump medication into a straight line (particularly if the straight line is running slower than the pump med). The accidental bolus effect can be dangerous.

That all being said I have never run cardizem as an IVPB - cardizem is a continuous drug so running it IVPB is counterproductive (you have a main line solution that is not being used). However, if you are considering IVPB as any med running into another line then I can see the confusion. Most places I have worked list IVPB as running into a main line above the pump, not below. It gets confusing because you can hang an IVPB at the closest port to the patient if one or both are free-flowing.

Confused?

IV piggy back (an iv solution running onto (or piggy backed) another mainline solution) - however, most places I have worked to differentiate tend to restrict IVPB to mean intermittant drugs vs continuous - so levaquin (IVPB), cardizem (continuous).

Hope this helps

Pat

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Specializes in Utilization Management.
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.

I'm confused. (I tol' ya this stuff was easier to do than to say, didn't I? :chuckle )

If I have Cardizem as the primary line, and I really want to stop it quickly, all I do is unplug it from the patient. Voila. No med sitting in the IVF line.

I should note that I'm only doing it the way our hospital policy dictates, and everyone should consider their hospital policy/pharmacy the final authority on the subject. Speaking of policy, we used to be taught to bolus off the pump and now we're told to bolus separately.

Also, tele nurses can bolus and maintain Cardizem gtts at our hospital. We can have parameters, but we cannot titrate.

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Specializes in Cardiac.
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'.

Time to change my contacts. I totally missed the word 'never' in your post. Sorry..

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Specializes in Cardiac.
I'm confused. (I tol' ya this stuff was easier to do than to say, didn't I? :chuckle )

If I have Cardizem as the primary line, and I really want to stop it quickly, all I do is unplug it from the patient. Voila. No med sitting in the IVF line.

Yep. That's what I would do too...

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Specializes in LTC, med-surg, critial care.

I think IVPB is getting confused with low porting a med. With a piggyback the primary infusion stops while the PB runs. If you "low port" a med then the regular fluids (NS, 1/2NS, ect) is running on it's own pump and another med (cardizem, ativan, ect) runs on it's own pump but the med with the slower rate is hooked up to the lowest port on the fluids that is running at a faster rate.

We will do this for two reasons. First, to keep the line open. If I have an ativan drip with a 1:1 ratio running at 2mL/hr I need to keep that line from becoming occluded since that rate is so slow. I run NS (or whatever the doc wants) at TKO to keep the line open because the ativan is running too slow to keep the line open on its own. Second, when we have multiple meds and two or three ports we need to combine lines to get everything in. Say you have a triple lumen. You need to run multiple meds, monitor CVP and run TPN. The CVP will take up one lumen, the TPN will take another leaving you with one lumen and multiple meds. So you have IVF with another med low ported on it. As long as any PB are compatible with all meds it'll work fine.

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Specializes in Cardiac Telemetry, ED.
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?

Hm, not really. "Piggyback" means that the primary fluid stops while the piggybacked med is running in, then when it's finished, it switches back to the primary. I don't see why you'd do that with a Cardizem gtt.

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I think IVPB is getting confused with low porting a med. With a piggyback the primary infusion stops while the PB runs. If you "low port" a med then the regular fluids (NS, 1/2NS, ect) is running on it's own pump and another med (cardizem, ativan, ect) runs on it's own pump but the med with the slower rate is hooked up to the lowest port on the fluids that is running at a faster rate.

Thank you "not now" for being clearer with the language. When I said "piggyback" I meant what you are calling "low porting". You said it so much better!

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Specializes in Emergency.

At my hospital we call it Y siting the drip. If the pt is on IV fluids and has Cardizem (or Amio, dopamine, Integrilin, Heparin, etc.) we will first ensure compatibility with the fluids. We will also look at whether the pt is getting intermittent IVPB's like antibiotics, Iron sucrose, etc. since you cannot run most heart meds with those drugs (if they are getting IV antibiotics or whatever also you need to start a second line for the heart med. We can run Cardizem as a stand alone infusion, ALWAYS on a pump, and ALWAYS assessing patency of the IV. We cannot stop a Cardizem (or other high alert med to give things like antibiotics, so most pts have either a second (or third) PIV in some cases, unless they have a PICC. When we run a cardiac drip in conjunction with other IV fluids, we "Y-site" it, which means that each drip runs through a separate pump (or in the case of multiple drip pumps, each is programmed separately) so the pt gets both at the same time.

If you piggy back something, you are stopping the primary fluid to administer the "secondary" med, not giving both simultameously. The "Y-site" is BELOW the pump and on a separate pump, while a piggyback is above the pump and intermittent.

Hope this helps.

Amy

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Specializes in ER/ICU, CCL, EP.
Time to change my contacts. I totally missed the word 'never' in your post. Sorry..

lol....it's ok. :) I was like....HEY! I almost NEVER disagree with you! :)

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Specializes in ER.

My concern is this, usually this is kind of question comes from having a current order. Where is your preceptor to answer your question, and why are you not checking hospital policy and why can't you spell the name of this drug properly? Call me suspicious, and call me being mean but having precepted for many years, it concerns me when new nurses ask questions like this on this board. Cardiazem is a very serious drug and if you have questions as to how you are to hang it and why, you should be checking with your preceptor and not waiting for an answer from this board.

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Specializes in ICU.

cardizem is run as a straight drip on a pump at my hospital. we rarely want the patient to have extra fluid running. if you're going to run a chaser with it, you don't want the cardizem to be the main line and it's better to run it in at the port closest to the insertion site. once the patient's heart rate is controlled for 24 hours, the gtt will be d/c'd an hour after a po dose is given.....usually 30-60 mg q6. if the rate remains controlled a long acting form is given. gtt rates are anywhere from 5-15mg an hour....keep a close eye on the heart rate as well as BP.....both can get dangerously low. hope this helps! :nurse:

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Specializes in Cardiac Telemetry, ED.
snip...and why can't you spell the name of this drug properly?..snip..Cardiazem is a very serious drug...

:chuckle

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