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Discussion

ICU Drips

I work in the ICU and would like to make a quick reference for titrating drips. My pharmacy doesn't have one. There are a few drips that I either have no experience with or haven't titrated in quite some time. I'm looking for what increments to titrate and how often. For example you typically titrate a Cardizem drip by 5mg/hr every 10 minutes or so. The drugs I'm looking for are:

  • Lasix
  • Lidocaine
  • Procainamide
  • Vecuronium

My hospital, unfortunately, doesn't have a policy on any drips, and we still have handwritten orders so no computer to reference. Any input would be greatly appreciated!

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    My experience with Lasix is 2.5mg increments based off hourly urine ml's.

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    There are some pretty good CC apps for this sort of thing.

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    Honestly its not a hard and fast rule that says you have drip X so you titrate it by 2mcg every 5 min. Best thing for you to do is to look each of these drugs up and learn the pharmacokinetics and dynamics of them. Then you would know how to titrate them better. Knowing the half life of these drugs will be a large help to you.

    The ones you listed don't have a lethal range really except for lidocaine. You need to know how much mg/kg of lidocaine you can give someone before you cause an overdose and send the patient into cardiac arrest. Lidocaine isn't something you really titrate but again I suggest actually looking up these drugs and fully understanding how they really work.

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    For vecuronium, have analgesia/sedation in place first usually versed/fentanyl. Off the top of my head, I think it goes like this:

    1. Start at 1mcg/kg/min

    2. Titrate by 0.1 mcg/kg/min q1hr as needed to get 2/4 TOF or no spontaneous breaths depending on provider

    Max rate 1.6 or 1.7mcg/kg/min

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