Metoprolol IVP rate

Specialties Emergency

Updated:   Published

Quick question:

How fast can one push metoprolol 5mg x 3 for acute MI that will be going up to cath lab?

Some of the literature I read states 5mg over 5min, some says 5mg over 2-3 minutes, some literature states rapid push with 2 minutes between doses.

I need a good book/PDA program for emergency meds. The "rules" often seem different for many meds used in the ED. Any recommendations?

Tonight I had a pt having an acute MI and nobody could get a peripheral IV in. The MD placed an EJ. Normally I like to have 2-3 lines to hook up all the meds for cath lab patients, but the one EJ is all we got :o . IV med orders included heparin drip, heparin bolus, metoprolol, nitro drip, reopro; it's not possible to get these all in through one line since time is muscle....

Specializes in OB, M/S, HH, Medical Imaging RN.

Your posts remind me why I'm so thankful I'm out of the chaos. I loved it for 30+ years. Now I shake just reading about the bully doctor. I have turned into a wimp. An old wimp. Thank you to all of you still keeping the beat going! I want you around when I or one of mine needs you in an emergency. You are awesome!

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Specializes in ICU of all kinds, CVICU, Cath Lab, ER..

Thank you Dutchgirl and thank you SWTooth... I printed your info for myself. Thanks again. Walk

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Specializes in Peds, ER/Trauma.

What's wrong with giving phenergan through a 24g hand IV??? If you dilute it & give over 2 minutes, there should be absolutely no problem with that.... We do it all the time in ER.

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Specializes in Emergency.

From the institute for safe medication practices website (https://www.ismp.org/?

Quote

Use large patent veins. Give the medication only through a large-bore vein (preferably via a central venous access site, but absolutely no hand or wrist veins).

I feel it's not safe to give phenergan through a 24g hand IV because of its vescicant properties. The patient I had referenced above was such a difficult stick; why ruin the IV site by pushing phenergan? Plus, the site was a capped IV.

With all the other excellent antiemetics to choose from, why push phenergan? I hope it gets banned by the FDA. I've been advocating for some type of ED policy on pushing phenergan at our facility (ie through running IV line, use a 20g IV or larger, only give it through sites above the wrist, dilute with 10-20ml NS or put in a minibag and run on a pump for 15 minutes, etc).

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Specializes in ER, ICU, Infusion, peds, informatics.
kmoonshine said:

I feel it's not safe to give phenergan through a 24g hand IV because of its vescicant properties. The patient I had referenced above was such a difficult stick; why ruin the IV site by pushing phenergan? Plus, the site was a capped IV.

With all the other excellent antiemetics to choose from, why push phenergan? I hope it gets banned by the FDA. I've been advocating for some type of ED policy on pushing phenergan at our facility (ie through running IV line, use a 20g IV or larger, only give it through sites above the wrist, dilute with 10-20ml NS or put in a minibag and run on a pump for 15 minutes, etc).

There is a big difference between a large-bore vein and a large-bore iv.

While I agree with you about not giving phenergan through a hand vein, giving it through a 24g iv is much safer than giving it through an 18g iv, assuming the veins are the same size.

Smaller gauge iv catheters take up less space in the vein, and allow more room for blood to flow around the catheter. This helps to buffer and dilute the medication, and reduces phlebitis.

If a central line just can't be placed, then the more irritating the med, the smaller the iv should be and the larger the vein needs to be. (large bore ivs are good for rapid infusions, blood infusions, and in some facilities, lab draws)

I agree with you about using other drugs. In fact, I agree with you about everything but the 20g or larger iv. 22g or smaller would be better.

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Specializes in Emergency.

Thanks for pointing that out CritterLover! It's great that a site like this exists so we can discuss topics and learn from one another.

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Specializes in Peds, ER/Trauma.
kmoonshine said:

I feel it's not safe to give phenergan through a 24g hand IV because of its vescicant properties. The patient I had referenced above was such a difficult stick; why ruin the IV site by pushing phenergan? Plus, the site was a capped IV.

Like I said... it's done all the time in ER's all over the country. I've never had any problems. Ideally an adult patient in the ER wouldn't have a 24g IV, but if it's all you can get, then that's what you've got to use.

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Specializes in Trauma, Teaching.

Quote:

Originally Posted by JBudd

When someone is in full cardiac arrest, the 2 minute push rule seems a little off doesn't it?

"Lopressor isn't given for full cardiac arrest...."

Sorry, didn't make myself clear. I was referring to how the rules seem changeable dependent on situation for a lot of drugs. Thanks for the clarification op!

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Specializes in Emergency, Trauma.

We do 5 mg IV x 3 doses, each 2 minutes apart. Then follow it 15 minutes later with a po dose. That's actually how its recommended by the manufacturer to give for acute MIs:

Quote

Myocardial Infarction

Early Treatment: During the early phase of definite or suspected acute myocardial infarction, treatment with Lopressor can be initiated as soon as possible after the patient’s arrival in the hospital. Such treatment should be initiated in a coronary care or similar unit immediately after the patient’s hemodynamic condition has stabilized.

Treatment in this early phase should begin with the intravenous administration of three bolus injections of 5 mg of Lopressor each; the injections should be given at approximately 2-minute intervals. During the intravenous administration of Lopressor, blood pressure, heart rate, and electrocardiogram should be carefully monitored.

In patients who tolerate the full intravenous dose (15 mg), Lopressor tablets, 50 mg every 6 hours, should be initiated 15 minutes after the last intravenous dose and continued for 48 hours. Thereafter, patients should receive a maintenance dosage of 100 mg twice daily (see Late Treatment below).

https://www.drugs.com/pro/lopressor.html

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Specializes in ER, Occ Health.

At my facility we push each dose over 2 minutes with 5 minutes in between and hold for HR

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Specializes in med/surg, rural, ER.

I'm so glad to read this thread! I read "rapid push" in one of my drug books (can't remember which one right now and don't want to go dig) and ponder my rate every time I give it. 5 min seems like longer than forever so I usually tend towards the 2 min push.

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