ICU nurses question - holding BP meds on pressors

[Bntraveler]

Hey guys, I'm a traveling ICU nurse, 3 years experience. Just wanted some opinions on a clinical judgement call. Small context, I was precepting at a new assignment and I had a septic patient (multiple comorbidities) with a surely poor prognosis. Anyways, patient was on small dose of Neo, in aFib HR 100-130. He has Scheduled metoprolol ordeded. I would generally hold this, and mention it to intensivist but preceptor was insistent that since we have wiggle room on Neo to give it. I gave it and went up a mild amount of Neo, patient was otherwise fine the rest of the shift. My first instinct was to call the hospitalist and see if he wanted to start him on amio of some form. But they were working with barebone staff and the nurse insisted that this was typical. I felt squirmy after the incident because I felt that he was being optimally managed. Context, he was in SVT earlier in the day so I kind of rationalized why he may benefit from it. He also had ivp lopressor that the md put in while he was on pressors. My question: has anyone else seen this at their practice? What might you have done differently ?

Thanks

[nrsang97, BSN, RN]

I have seen this done, to regulate heart rate.  However is is counterintuitive to me. 

[Loco-Bonita, BSN, RN]

I have not seen this in our CVICU. Our practice is to hold BB if they are on any type of pressors. If rate control is an issue, we call for a different medication for rate control.