Insulin and Levophed drips on cardiovascular unit

[heartnurse2012]

This is something new coming to us nurses on the floor, we have 4 pts each but somedays it can be 5 pts. We have an A side which is the more critical and post op day 1 CABG's then the B side which aren't as critical. Total of 48 rooms.

These drips are usually managed in the ICU, any tips or points to bring up in the future unit meetings? Many of us are worried.

[liebling5, MSN, RN]

Facility management expects a floor nurse to manage Levophed drips? That is an ICU RN function, or at least a Step-Down RN function. Insulin drips would be a stretch because of the every-hour accu-checks that would be required. Of course, patients on pressors also are on every-15-minute blood pressure checks. Perhaps you can point them to the phrase "qualified and experienced" in the job description?

Are you unionized? This is definitely an issue for the union. If not, perhaps your local health department, your state RN board might have some help. Also, CMS (Centers for Medicare/Medicaid Services) are a great resource. Tell them you have a concern about this plan. They just might show up unexpectedly to survey the facility :)

[sapphire18]

I've never heard of this. Insulin, maybe yes. But levophed?? Not safe if you have 4-5 pts IMO.

[akulahawkRN, ADN, RN, EMT-P]

I'm not a nurse yet but I just can't see Levophed being safely done by a nurse that has 4-5 patients. Insulin drips could be possible if the load is light, say 3-4, because of those hourly blood glucose checks. Levophed? That would be a maybe for perhaps up to 2 patients. I had to become familiar with pressors (dopamine and levophed) in a previous career (might as well be a lifetime ago) and I just can't see it being safe much past a 1:2 nurse/patient ratio. I just can't. The technology just isn't there yet to allow for a machine to titrate pressors to vital signs. The ability is coming down the pike at us, I'm sure, but that's not reality yet, as far as I know.

[NJmurse18]

Patient safety is being jeopardized. Plain and simple. I would call my union and file a grievance.

[CrufflerJJ, BSN, RN, EMT-P]

Safety could be improved by establishing a nurse:pt ration for those pts requiring insulin or levophed drips. At my facility, the "intermediate' (ICU stepdown) unit canmanage pts with a single vasopressor, including levo. Those pts, however, are "ratioed".

To try and manage a pt o a pressor drip while handling 3-4 other pts is not safe.

[KBICU]

I work in ICU stepdown and we have insulin gtts for the post up cabgs with a full assignment, but NEVER would have Levo....levo requires invasive monitoring. We do the usual cardiac gtts including neo but never Levo, Epi, Vaso, etc

[Esme12, ASN, BSN, RN]

It depends on your unit. Insulin gtts I have seen on post CVICU surgical step down....but levo....never. Do you have invasive lines on your units? or is this peripheral?

I don't think having a patient on Levo/Neo/Epi/Vaso without an arterial line and a multi-lumen is not safe practice. What have they said their rationale is for this decision?

[ED_nurse423]

Levophed is pretty intense medication usually only used in the Ed or icu setting. You must be aware of the side effects of the drug and what can happen. That drug is no joke

[eatmysoxRN, ASN, RN]

Do your rooms have monitors in them with the central monitoring as well? If not, I don't think a patient on any intense cardiac drip should be on that floor. I would feel unsafe taking more than 3 (max in the icu at my facility) patients. Management is ridiculous expecting high acuity with less staff. I don't think drugs like levo have a place outside of an ICU.

[Altra, BSN, RN]

Oh my. Insulin, yes. Levophed, not happening. A patient on a Levo gtt is unstable by definition.

As an aside though ... and something to think about in case your management brings up this point ... an ER nurse may indeed have a patient on one of those gtts AND 2-4 other patients at the same time. The flow is completely different, though.

[08RNGrad]

As many stated, Levo is NOT safe. My additional point is...insulin gtt's can be VERY time consuming. I've had a number of patients who did not immediately stabilize and were hourly blood glucose tested and constantly titrated. That WITH levo with those ratios is crazy. Could risk mngt help? I would NOT want my family member on a unit such as that.