Lasix gtts

SleepyheadRN · Feb 21, 2009

On our unit we monitor BPs hourly for a Lasix gtt. Anyone's hospital using Aquaphoresis? (hope I spelled that right) We just started using it. Works somewhat like dialysis. Does the same job for CHF-ers without the kidney damage.

cruisin_woodward · Feb 24, 2009

If you are in an ICU, aren't you doing q1hr VS and strict I&O any way? Not to mention mo itoring all labs q24hrs, and replacing electrolytes as needed? I don't think any thing else is necessary other than looking at each PTA clinical picture and tweaking is as needed. Seems like common sense?

metalikos80 · Feb 24, 2009

helloo....thers no real protocol for lasix actually...we are doing such monitoring of I&O,V/S hourly in ICU by theway..and electrolytes as per MD orders.

uncleb · Mar 1, 2009

I think you thinking is online with patient safety, which should be your priority in any situation. My Nephrologist told me that the usual dose for lasix (his standard) is decided by the pt's Cr times their age. That is for a large dose IVP or IVPB times one or serial times 4. At the point of needing a Lasix gtt, I would agree with some of the other replys, in that, kidney function has declined significantly. However, there is no way to assure that you pt will not respond to the Lasix gtt. That is why I would ensure that the foley drainage bag has a graduated chanber on it. Also, my Nephrologist recommends to titrate any diuretic gtt to achieve no more than 150cc urine output an hour. This would have to be ordered of course. But let's think logically about this. 5 times the normal urine output can't be "normal" or "okay" for anyone. Plus what is pt's cardiovascular staus looking like? Normal urine output for adult is 30cc/hr and if the pt, even if they have horrible kidney functions, can produce massive amounts of urine. Some patients are even prone to Diabetes Insipidus and need to be watched even closer. So my suggestion is question the MD on what paremeters he would like for the K and urine output. Also, I am sure your pt was on Tele but that is a must when playing with fluid/electrolyte balance, so if it's not ordered ask him/her that as well.

From experience, I saw a nurse run a Lasix gtt in without monitoring the pt's urine output for a period over 8hours. Let's just say that the pt produced 10,000cc of fluid in a 12hr shift, the tech failed to mention that till end of shift, and a K of 2.5 kept the next nurse busy for a while.

Good luck

pawashrn · Mar 1, 2009

It is a nursing measure to take a patient's b/p as the RN deems necessary, you don't need an order, I assume you are on a monitored unit, watch for ectopy. frequent assessment of neuro status. observe the amt of u/o. common sense over-rides policy. these are all things you as a RN can do with out the intervention of a policy or a doctor

athena55, BSN, RN · Mar 1, 2009

Hello

Well not to "split hairs", ....Well I guess I am...Urine output is now calculated based on weight. So that old 30 ml/hour or 40 ml/hour or even 15ml/hour is no longer used....Ideal hourly urine output should be no less than 0.5ml/kg/hour

Just my :twocents:

athena

cardiacRN2006, ADN, RN · Mar 1, 2009

Hello
Well not to "split hairs", ....Well I guess I am...Urine output is now calculated based on weight. So that old 30 ml/hour or 40 ml/hour or even 15ml/hour is no longer used....Ideal hourly urine output should be no less than 0.5ml/kg/hour
Just my
athena

You beat me to it!

I always cringe when I see someone say "30mL/hr". I find some docs that still think this too...

cruisin_woodward · Mar 1, 2009

Hello
Well not to "split hairs", ....Well I guess I am...Urine output is now calculated based on weight. So that old 30 ml/hour or 40 ml/hour or even 15ml/hour is no longer used....Ideal hourly urine output should be no less than 0.5ml/kg/hour
Just my
athena

Really? I haven't heard of that, but it makes sense...do you have any more info that I could take back to the ICU?? Thanks!!

cardiacRN2006, ADN, RN · Mar 1, 2009

0.5mL/kg/hr-1mL/kg/hr.

It was in every one of my nursing textbooks and beaten into my head by my instructors...

pawashrn · Mar 1, 2009

mmm.therefore fat people or people with fluid overload should pee more than skinny people. Actually, shouldn't you be looking at creatnine/BUN fluid intake. Also, not to split hairs, I stated to monitor u/o, I didn't state per kg or hourly rate. just a clarification for those in the know.

athena55, BSN, RN · Mar 1, 2009

Sorry I should have stated I was addressing Uncleb

And ideally you really should look at your BUN:Cr ratio which would give you a way better idea if it is pre-renal vs intra-renal vs post-renal.

The ABSOLUTE IDEAL is what factors could be affecting your GFR such as NA and H20. The renal regulation of both of these is the most important mechanism for volume regulation in the body, period.

And when someone is talking about weight hopefully that practitioner is talking about dry weight, especially when thinking about titration of various drugs...And no PaWashrn, you hadn't mentioned dry weight, I just did:D And I agree with you, Cr Cl is a far better measurement

athena

MMARN, BSN, RN · Mar 10, 2009

Hello
Well not to "split hairs", ....Well I guess I am...Urine output is now calculated based on weight. So that old 30 ml/hour or 40 ml/hour or even 15ml/hour is no longer used....Ideal hourly urine output should be no less than 0.5ml/kg/hour
Just my
athena

I actually hadn't heard of that. In my floor, we still use the "old" at least 30ml/hr. That was what I learned in nursing school and what was beating into my head. The doctors I work with think the same way. Is this only in critical care areas? I work in telemetry and it hasn't been the case.

As for the lasix gtt, we usually don't do many in my floor. I've done a couple, and every time, it has been for hyperkalemia. No protocols, just vs per floor protocol (q4hrs), and k+ monitoring the next day.