Nitro for c/p vs hypertension

[CathRn37]

Currently my hospital has the following:

Tele nurses may titrate nitro for chest pain. if nitro titration needed for blood pressure they must go to the ICU. I find this a very inefficient use of critical care beds, unnecessary patient movement, and feel that properly trained tele nurses should be able to do either.

I am currently trying to change this so my question is; how do your facilities approach RN's giving nitro gtts?

what resources, re articles, studies etc. were used to arrive at that method?

thanks everyone for any input.

[Here.I.Stand, BSN, RN]

The cardiac RNs in the group might have better info--and I have worked in a CVICU but it's been a long time--but I've only seen nitro gtts used for chest pain. As a cardiac vasodilator but not so much a peripheral one, BUT one that can have icky side effects like that headache, it just isn't ideal for someone who needs BP control. In my current ICU, our docs tend to favor Nicardipine if someone needs to be on a gtt for HTN.

And yes, I do believe that if a pt is needing a vasoactive gtt for their BP, he/she should be in the ICU. It's not a matter of tele/stepdown RNs not being "able to be trained," or "properly trained," but that it's wildly unsafe with the kind of staffing ratios they have on the floor. It's just too difficult to closely monitor the pt every couple of minutes to ensure that they're getting the appropriate rate at that moment when you have four other pts to assess, medicate, ambulate, toilet, call MDs on, answer family questions and phone calls, do Dietary's job and getting requested food, draw labs etc. etc. etc.

[firstinfamily, RN]

I think they should be in ICU also, mostly because of the need for more frequent vital signs. It is true the RNs on the tele unit could most likely titrate the medication, but getting the blood pressure in a timely manner would not be feasible due to the RN to pt ratios are so much higher. It does seem the same medication should be used on the tele unit as in the ICU, but the availability of RN is the issue. I have used NTG for both B/P and chest pain problems.

[Here.I.Stand, BSN, RN]

I should clarify, I have *heard of* using Nitro for BP, but haven't seen it in my own practice.

firstinfamily--exactly! We have to check a BP minimally q 15 minutes with vasoactive drips...but generally the pt has an art line and is being monitored continuously since that frequent cuff pressures would drive someone batty. Plus it's not good for the skin. That's just not feasible on the floor.

[nowim clean]

Nitro titrate is sent to unit good thing too since now we are taking more patients to nurse and are unable to monitor as closely as a nurse with only 2 patients. There was a time when tele was for cardiac issues but now we admit everything to our tele unit to the point it looks like med/surg and with all the float nurses it's just unsafe.