Looking for general insights on a few common drips ...

[danattherock]

I am starting a new job next month and will be using some drips that I have not used as often in the past as I would like. In some cases, drips I have not used at all. In most cases, meds I am familiar with and have used of course, but not in drip form. I have read the information in the drug books and got a basic jist on things. So for anyone willing, share some basic thoughts on why a doc would order the below drips, what is the associated pt condition, what is the expected outcome, any particular things to be mindful of, etc.. I will be working on a Progressive Care Unit and it is my intention to hit the floor with my feet running. Also, researching things helps with the nervous energy as I am quite excited about the new job. Thanks for any and all comment.

Amiodarone

Dubotamine

Lido

Lasix

Heparin

Dopamine

Insulin

Cardizem

[PAERRN20]

Cardizem- usually give a bolus then start the drip at 5mg/hr, at least in my facility. Watch the HR, BP. Titrated up as needed depending on HR. If used to convert a rhythm (A-fib to NSR, for example) get a repeat EKG after conversion.

Amiodarone- always use a filter, continuous cardiac monitor.

Insulin- mix 100 Units of regular insulin in 100 ccs of NS. We check glucose q1hr. Some MDs like to write an order to hang D5 with Insulin...sounds crazy but it is to keep the glucose from falling out in some cases.

Dopamine- take BPs q 5 mins, continous cardiac monitoring

Lasix- hope you have a foley in place so you can do accurate I&Os, monitor potassium and lyte levels

Heparin- you can mainline this drug if needed, but I always hand NS as the primary drip, espcially if you have Nitro running as well. Again, usually a bolus given before the gtt is start, keep a eye on the coags

[Esme12, ASN, BSN, RN]

All units have set policies and procedures for the administration of drugs and titration of gtts. you need to follow your facilities policies and procedures.

http://www.rxlist.com/reopro-drug.htm

http://www2.kumc.edu/pharmacy/guidelines/IV%20Drip%20List.pdf excellent resource.

[danattherock]

Thanks to the both of you for sharing some insights. Anyone else, feel free to chime in. As with insight into anything, more is always better.

[nminodob]

I work progressive care/ICU stepdown. Outside our expertise to hang vasopressors, but we hang amio (too convoluted a protocol to go into here, let's just say you and at least 1 other nurse will be reading the protocol line by lione as you follow, and the tele nurse will also be involved).

We hang insulin as well, but generally q 4 hour fingersticks - most times in progressive care the charge nurse (where I work anyway) will refuse a pt if they require 1 hour ANYTHING - too much manpower involved since we have a 3:1 ratio. But there are times we do 1 hour checks for a short span of time, like DKA in a brittle diabetic.

Heparin drips, pretty stright foreward, q 4-6 hour PTTs, just remember to shut off the drip before the lab draw or draw from a site a safe distance from the heparin, or you will get a bogus result.

I have never seen a lidocaine drip in progressive care, but I gues anything is possible.

And of course, most of these drips (especially insulin and heparin) require 2 nurse signatures. And it doesn't hurt to get another nurse to eyeball any drips you have hanging - just in case!

[Up2nogood RN, RN]

We can have insulin, heparin, morphine and Amio gtts on our surg onc floor and we always have a second RN verify and physically look at the order and settings before co-signing. At initialization, any rate change, any bag change, and change of shift we need to have a co-sign with another RN. It can be a pita for insulin gtts when changing the rate Qhr but protect your license and remember to follow your facility protocol!

[Goodyear]

Love the info...thanks guys!

[danattherock]

Yes, same here. Thanks for the input so far.