New to CVSICU...cardiac gtts

Specialties CCU

Published

Hi everyone! I am a new nurse in the CVSICU. Just completed my first week of orientation and wow there's alot to learn!! I was wondering if anyone had any advice on learning the cardiac gtts. Especially in regards to titrating which makes me nervous. Any study tips?

Thanks for your help!

Specializes in Trauma/Tele/Surgery/SICU.
It comes in time and experience....I know when I started out in ICCU I depended ALOT on the senior nurses (10+y) to show me the tricks of the trade...it's a shame that learning model is no longer used and the older nurses are no longer considered valuable.

Absolutely! Identify nurses you can use as resources on your unit. They are your best friend! It is a shame we value educational attainment and certifications over experience. Nothing beats experience!

OP, Make a list of the drugs you see most frequently used and then basically memorize its mechanism of action, what effect it will have on your patient, what your facilities acceptable dose range is, potential adverse effects, etc. It also really helped me to know what receptors were involved.

Titration comes with time and experience and depends on patient's response. Each nurse develops their own way of doing things. My preceptor told me I should always titrate by twos, some told me by fives, etc. I try to look at my patient's response to guide me. For instance if I am on Levo for hypotension I am going to be much more aggressive if my BP is 60/30 as opposed to 85/45.

Up Vote Up Vote ×

Thank you everyone for your help. My next issue I have is performing the actual drug calculations for the gtts. I've been working on practice problems but I'm still have some difficulty. Any advice?

Up Vote Up Vote ×
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

This site may help....it says for students but it is a great site.......DosageHelp.com - Helping Nursing Students Learn Dosage Calculations

YOu might also want to get a weight based pocket reference

CRITICAL CARE INTRAVENOUS MEDICATIONS CHART

IV Critical Care Infusion Drip Chart

Appendix D - Drug Calculations Sheet

Calculations

Up Vote Up Vote ×
Specializes in ICU/CVU.

In our ICU/CVU we have our specific hospital policy and protocols (thank you State of CT for your constant visits and citations) for EACH and every titratable gtt (begin infusion at .... titrate by .... max infusion rates, etc...) Each room has it's own protocol sheets/book in the room.

Up Vote Up Vote ×

I just recently started in a CVICU as well.. I am nervous as to drips as well.. Ive worked in a Busy Emergency room, so its not like I havent see many of these drips, but titrating 5-6 at a time is quite different!

When the patients come out from surgery, they already come to me with most everything hanging... Is almost everything compatible? It seems that no matter what drugs they are on, they are always running through the same cordis... and whenever I need to hang a new med, Im doing IV interactions with ALL the drugs running through that line... it seems a little tedious... anyone have any info to shed on this?

Up Vote Up Vote ×
Specializes in Intensive Care Unit.

In my ICU we usually have triple leumen central Lines with multiple manifolds. I usually designate one specific one to just IV fluids (keep it on the same side as my CO stuff) and keep my drug manifolds on the other side. I also label ALL my meds!! I like to separate drugs as much as possible even if compatible so I can turn off or turn up the rate on something as soon as I need to.

Up Vote Up Vote ×
In my ICU we usually have triple leumen central Lines with multiple manifolds. I usually designate one specific one to just IV fluids (keep it on the same side as my CO stuff) and keep my drug manifolds on the other side. I also label ALL my meds!! I like to separate drugs as much as possible even if compatible so I can turn off or turn up the rate on something as soon as I need to.

Separating compatible drugs is a wonderful suggestion, and I always try to do this. You never know when you may need to run your IVF in quickly, and you don't want to risk bolusing several drips in the process!

Up Vote Up Vote ×

To AMAC8487: "everything is compatible in the world of anesthesia"...sorry, that's my little joke! But you will find that it seems true! Although it may vary at your facility, generally, all the pressors are compatible together and can all go with propofol. Dilators go together usually. Insulin, fentanyl, propofol ok. Amiodarone and bicarbonate compatible with very little so best to run separate! We have an idiot sheet for drips, but hearts are managed differently. Hearts have a bunch of lines and ports; trauma surgeries have a 1 port cordis...so yes I do understand. Hope this helps!

Up Vote Up Vote ×
Specializes in Critical Care.

I'm fairly new to SICU myself. We have a binder with our drip protocols on the unit--always important to check this. I find that the most important thing for my learning style is to know the physiological response to each drip. Does it work by constricting the vessels or stimulating more cardiac output?

I say this because when I was new, I simply wanted to get the patients blood pressure up to a point where I was comfortable and didn't care how it got there. But, now I realize that it is more important to treat the reason that the blood pressure is low to begin with. If volume is low, a pressor may not be necessary and if too low, even harmful. There should be enough volume to "press".

As far as titrating, I've just followed my facility protocol and go by patient's response. It seems that in my short time in ICU, I've only had two types of patients--the ones who respond to small increments in titration, or the ones that want to crash no matter how fast I up the pressors.

icufaqs.com has tons of good info!

Up Vote Up Vote ×
To AMAC8487: "everything is compatible in the world of anesthesia"...sorry that's my little joke! But you will find that it seems true! Although it may vary at your facility, generally, all the pressors are compatible together and can all go with propofol. Dilators go together usually. Insulin, fentanyl, propofol ok. Amiodarone and bicarbonate compatible with very little so best to run separate! We have an idiot sheet for drips, but hearts are managed differently. Hearts have a bunch of lines and ports; trauma surgeries have a 1 port cordis...so yes I do understand. Hope this helps![/quote']

I have nightmares about the septic pts in my old I/CCU. Our intensivist loved running bicarb drips , it was like musical chairs with drips. Luckily in Cvicu I don't have that problem lol

Up Vote Up Vote ×

Thanks for the excellent web sites!

Up Vote Up Vote ×

Hey there! There is this website that is a bit outdated but has useful information, I think it is called new in the ICU? I think if you google it it should come up and it is very helpful. I wish you all the best!

Up Vote Up Vote ×
+ Add a Comment