need help with drips and PCU patients

[kcam213, BSN, RN]

Hello,

I am considering applying for contingent ICU/PCU position.

My dilemna:

I have 2 years recent MICU/telemetry experience but my ICU was not aggressive. We did not use Swanz or any type of neuro ICU, nor fresh post open hearts.

most of my patients were DKA, new onset diabetes on insulin drip, shock - cardiogenic and septic shock, resp failure (with intubation), DTs, acute GI bleeds and cardiac arrhythmias.

I feel very comfortable caring for these patients, but really have had little experience with any other critical patient care.

I think I could function on a PCU since I have been told my hosptial's ICU is more like bigger and busier hospital PCU.

Question:

What exactly is entailed caring for patient monitored with a Swanz? I am currently working in cath lab and now I am able to recognize the different wave forms for a Swanz.

Besides monitoring for good wave forms and pressures, what else is involved monitoring a Swanz patient?

Also,

It has been long enough since working in ICU (16 months) that I have forgotten the best START rates for drips. Most of the time when pt is crashing, the doctor will order a pressor "titrate for SBP >90" etc. I could always ask a senior ICU nurse what rate would she START the drip if I wasn't sure. I know I always started lower than most experienced ICU nurse (being nervous).

I don't know how comfortable I would feel asking a nurse in a contigency situation at what rate to start a drip.

Is there a standard on start gtt rates for Levo, Neo, Dopa, Nitro, propofol and if so where is the information?

Is there a good book? I have a critical care text book and also core curicculum for critical care nursing. But these books basically cover the body systems and critical issues that can affect those systems... but neither really address drugs rates and titration rates. Just the action of drug and s/e to be aware of.

I would really like to go back to critical care nursing on a limited basis because I love it so much. (I had to leave unit for home schedule issues). I think a contingent job would fulfill my need for critical care nursing. But a coworker warned me to beware; staff nurses will dump on me and will not help if I am contigent. I risk major catostrophe that could jeopardize my main job and license by screwing up in contigent job.

And most important, I don't want to be the difference (negative) between a critical ill patient surviving or not surviving the night because *I* got him on an assignment.

So I am wary.

Would do you think? and also a reference book on critical meds START rates for titration.

Thanks

[resumecpr]

Try Mosby's CCRN prep book for info re:SWANZ. Not sure about the start rate for critical gtts. I have just learned and memorized over time. I would think that any general drug guide for nurses would work, but most hospitals have policies and protocols for their critical drips so be careful with that. Good luck! Happy Nurse's Week!

[sunnycalifRN]

Kathy White's Fast Facts for Critical Care is a great reference and it covers many areas of critical care nursing. Regarding starting rates for drip meds, the reference book is helpful but most of the time, the order itself has a dosage range or the ICU will have protocols for the various drips. Good luck.

[BellaInBlueScrubsRN]

Our ICU keeps a copy of the ranges for IV titratable gtts. When I first started I made a copy in a shruken size so I can carry it in my pocket. That way I don't have to go look up something I don't know in a critical situation. It is really invaluable. I just play the titrating thing by ear kinda. Depends on the pt. If the BP is somewhat stable, just a little low--start from the minimum dose. If its in the toilet (like 50 or 60 systolic) start from the top is what I learned! Then bring it down. We don't have protocols for starting rates to always use, like always start levo at 10, or anything. Every situation is different.

[kcam213, BSN, RN]

Thank you for your replies. And the previous poster thanks a bunch. I don't know why I never thought of your titrate logic before! It makes perfect sense. Now I feel more confident. I guess pcu will not have lot of gtts. More like our telmetry unit. I will memorize the ranges and like you said if the pt is more stable start at the lowest and titrate up and ifot is circlng the drain just go for top rate and titrate down. Thanks a bunch!