Latest Comments by damanRN

damanRN 678 Views

Joined: Mar 3, '10; Posts: 7 (29% Liked) ; Likes: 9

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  • 0

    i believe at the open house they said they accept 22-26 based on the number their clinical affiliates will allow. Also said invites sent out sept/oct.

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    Interview in about a week myself, interested if anyone has as well and what type of ?'s they ask.

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    Quote from marty6001
    The other day I ordered the Levo at 50mcg on a patient with a ruptured thoracic aorta... It bought us time for the family to get in... usually however, once its at 10mcg time to add a second agent and I'll stop at 20

    Why stop 20? personal comfort or literature based?

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    Quote from lakemurray
    Apparently you cannot read. I even posted the web link. Levo requires a central line. Also where do you people work at that you give vasoconstictors without central lines? In the er while waiting for a line maybe, but not on a unit. I have not worked in a unit where we put any vasoconstricter without a central line for at least five years. Think about it. If its not going in (extravasating) whats it doing for you patients blood pressure. That sad nonsense about your wife going to die but we can't use a vasoconstrictor peripherally is nonsense. The first thing your going to do is a fluid challenge and while that is going on you get a central line placed.

    why would it say infuse into large vein if it can only be given in central line? are people putting central lines into small veins? The websit YOU sited states
    "Administration: I.V.
    Administer into large vein to avoid the potential for extravasation; potent drug, must be diluted prior to use; do not administer NaHCO3 through an I.V. line containing norepinephrine. Central line administration is required. " The central line is required statement is r/t the NaHCO3 and levophed combo. it goes on to say
    "Administration: I.V. Detail
    Administer into large vein to avoid the potential for extravasation." The ac is a large vein.

    Up to date removes the ambiguity of the merk info. look up levophed on up to date you'll find this:
    Administer into large vein to avoid the potential for extravasation; potent drug, must be diluted prior to use; do not administer NaHCO3 through an I.V. line containing norepinephrine." same exact thing without the central line confusion.

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    quoted to second your post

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    Quote from detroitdano
    If your patient is about to croak you can run Levo peripherally. It's better than the alternative if you don't have a central line.
    Quote from lakemurray
    If you go to Merck's drug site it will say that levo should be given through a large vein and must be given through a central line. look for I.V. administration. Your hospital should have a policy about drug administration. Every hospital I have been to has had a policy about administering vasoconstrictive drugs through a central line. Extravasation will cause necrosis. That being said it looks like you are a new nurse and you probably do not want to make too many waves.
    Quote from NtannRN
    Never Levo Peripherally - ever. where I am but we DO use Neosynepherine peripherally. The low dose and usually for a very short amount of time. Usually our surgical patients get a "spash" for a little while. Or while we wait for out lovely residents to put in a central line.

    I think you need to go back and reed the Merk manual again. It says levo only through large vein, the must be given through a central line is when given with bicarb. All of this talk (by multiple individuals) about "never through a peripheral" is ungrounded. "Sorry sir, I have this medication that could restore perfusion to your wife's organs and possibly save her life but I won't give it because she only has a peripheral I.V." Not all patients have a central line and not all hospitals have a doc (willing) to put one in on a stat basis. Assess the site frequently and have regitine on standby if need be until they have a central in place.

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    RN1980 and danamobile like this.

    Quote from MarkoRNCNS
    It just blows me away to read what nurses are writing here.. 100mcg + of Levoped is really negligent practice no matter what a doctor tells you.. you have nothing to back you up... sometimes perhaps the tank is empty so no matter how much you squeeze it you are not going to get an adequate BP.. perhaps an inotrope is needed etc.. giving super high dose pressors has been proven to be detrimental to patient outcomes... in our unit 30mcg is the max .. a good clinican is more comprehensive in approach than just titrating up and up and up.. furthermore MAP should be used as guidance for titration and not SBP..... im dissapointed in this age of evidenced based practice and patient safety that nurses would go along with this.... NOT in my unit !
    Where is this evidence based practice you speak of? Up to date says 8-30mcg/min is the "usual range" but does not give a maximum. Up to date goes on to say ACLS range 0.5-30mcg/min, but also gives an "alternative weight based dosing" of 0.01-3 mcg/kg/minute. For a 100kg patient that is 300mcg/min. negligent practice really?