Natrecor and dobutamine drips at the same time

[firestoney]

I had a patient last night that the MD asked me to run a natrecor gtt and a dobutamin gtt at the same time. Can someone explain why both at the same time?

This was a CHF pt with severe SOB and cardiomegaly and EF 20%.

[blondy2061h, MSN, RN]

It sounds like he was trying to increase cardiac output and was looking for a synergistic effect, or at the very least, more effect than either drug would have individually. Was it a heart failure patient?

[firestoney]

Yes, he was CHF. I knew that Natrecor was a synthetic BNP that made the heart contract stronger, but isn't that what dobutamine does? I just kept second guessing myself all night about if I should have run the drips at the same time, even though his notes said that he wanted the natrecor "as well as" the dobutamine.

[blondy2061h, MSN, RN]

Were they started at the same time, or was one added after the other?

[Altra, BSN, RN]

I'm not aware of any contraindication to running both concurrently.

This is the equivalent of running multiple pressors at the same time, or even maintaining a maintenance regimen of, say, multiple p.o. antihypertensives.

[Biffbradford]

We had one surgeon that was into that drug for a while. I might be wrong, but doesn't Nesiritide do a good job of reducing wedge pressure so therefore reduce the load of the right heart, whereas Dobutrex reduces SVR, lightening the load of the left side? I think it was super expensive as well. Like I said, it's been a while, so that may be off.

[highlandlass1592, BSN, RN]

Without talking to that MD directly and not having access to this pt's history, I would guess he was trying to alleviate CHF symptoms (using Natrecor) while supporting overall function (Dobutamine). I haven't used Natrecor in years, due to some neagative outcomes patients were experiencing (our docs won't touch it)

I'm gonna be honest with you, there is no reason not to seek out information on this board and I applaud you for it. But why didn't you ask that doctor directly? It sounds like to me, this was your patient and you weren't totally clear on the intended plan of care. You have a legal right and responsibility to know what's going on with your patient. Again, view from the cheap seats here, and I don't mean to sound harsh....just so many nurses are afraid to confront docs directly, fear they will get yelled at or made to look ignorant. At this stage of my life, I personally don't care about either. My personal nursing philosophy is that is MY patient, we aren't doing anything till I understand the why! Anyway, just a thought. I'm also advocating for nursing with my current peers (long story as to my current job situation) and my working peers are PA's...they are ALWAYS bashing nursing. Sorry didn't mean to sound preachy....apologies.