Lopressor drip

[traumagirll99]

I hope someone here can give me some info on this. I am working in a 22 bed ICU(mixed census of coronary/surgical/med- little of everything). This past week I was assigned to a pt who had suffered a SAH and was placed on a Lopressor Drip for b/p control. The drip had been started at 1300 and when I came on at 1900 her b/p was still elevated at 170s/100s. During the shift report the off going RN had told me that she had been titrating the drip and it was going at 0.7mcg/kg/min. After report I went in to assess the pt and found indeed that the drip was going at that rate but was loaded into the IV pump and labeled Levophed not Lopressor. The patient was in no distress. I must admit I was not familiar with using lopressor in a drip form usually we give it as a bolus push for b/p not cont infusion. when I reviewed the order the md had written it simply said Lopressor Drip to keep sbp less than 140. So i called the pharmacy and asked them if they had any reference info on giving lopressor this way so that i would be titrating it correctly and was told that the PHARM was unable to find any references for this use and had simply mixed the drip and sent it to the ICU.

Next I went to my own reference books and my charge nurse and we both had never heard of using Lopressor this way and could find no references in the books or on the computer.

well by this time my next b/p was still elevated and the pt's heartrate was now about 46 after having been in the high 50s all day (even before the drip was started). So i turned off the medication and paged the attending md. When he returned the call I explained to him that 1.the medication was having no effect on the b/p but had lowered her heartrate 2.i needed some clarification on how he wanted the drip given; mcg/kg/min mg/hr etc. After a pause he said "Wellhow do you all normallly give it?" I told him that we didn't and that pharm and the icu staff could find no guidelines or references for this use. Then came the question all ICU nurses love to hear "Well want to you want to Use?" I suggested nipride since labetolol had already failed. So that's what I ended up hanging andhad b/p control within the next 1hr.

So after my long vent my question is Has anyone been using Lopressor as an infusion not as a bolus? If so I would love to hear your facilities guidelines or any references you know of.

[ER4LifeRN]

I have seen a lopressor drip used once or twice but I'm not sure how orthodox it really is. When I have given it in the past though, it's never been weight based. I can't attest that this is 100% correct but its what the pharmacist told me when he mixed my first bag. So, I just gave it as mg/hr. I believe I started my drip around 7 mg/hr (which seemed like a pretty tall dose) to maintain a BP

[ghmccart]

I wonder about using nicardipine for vasodilation, never used metop gtt, wouldn't, that night RN let it fly way to long, but good job dealing w it. thats why good thorough saftey checks always pay off!