Nitroglycerin drips on telemetry units

Our cardiac floor which is the main floor for post-caths and 1 day post-op CABG's take patients on NTG drips up to 50 mcg/min. After that they are required to be admitted to our CCU.

Our cardiac floor which is the main floor for post-caths and 1 day post-op CABG's take patients on NTG drips up to 50 mcg/min. After that they are required to be admitted to our CCU.

What kind of special care to you give the patient

What kind of special care to you give the patient

I'm not sure what you are asking here. They are monitored continuously and routine care is given.

Our cardiac floor which is the main floor for post-caths and 1 day post-op CABG's take patients on NTG drips up to 50 mcg/min. After that they are required to be admitted to our CCU.

This is what most post-cath and post CABG units do. We are talking stable patients here, not in need of more than very little titration (and usually downward at that). To stick a completely stable person on a NTG-drip in an ICU/CCU bed is often a waste of resources and financially not a good thing.

This is what most post-cath and post CABG units do. We are talking stable patients here, not in need of more than very little titration (and usually downward at that). To stick a completely stable person on a NTG-drip in an ICU/CCU bed is often a waste of resources and financially not a good thing.

Our tele stepdown nurses can wean Nitro but are not to titrate upwards.(sometimes they tweak this rule by getting a specific order from the doc to turn it up if need be, but this is selective) The stability of the patient is the deciding factor as to whether the patient needs to go to ICU or stay on PCU/tele. I agree that nitro drip alone is not a good reason to take up an ICU bed in these times.

Our cardiac floors nurses titrate NTG up until it hits 50 mcg/min after that the policy is they go to the CCU for closer monitoring. That's then only time the NTG is the deciding factor. Of course, if the patient's condition warrants it they can go sooner than that.

But, if it's ONLY the NTG, no we don't take up the bed until it reachs 50 mcg/min.

Thanks you were all very helpful. Something new always seems threatening. My biggest fear is that we will get every CHF patient that comes through the ED doors. It sounds like it won't be much different than our natracor or dardazem etc drips.

Again thanks

Another thought along the line of tele patients. Some larger hospitals are starting to do tele monitoring on patients in non tele units. These patients get monitored from a distant central location. If a problem occurs the monitor tech contacts the nurse on the floor to eval the pt. Example Mr Smith has a distant history of A-fib and is having a knee replacement. So instead of using a badly needed tele bed for a patient that really needs it, a tele monitor is placed on him on the ortho unit and he is watch from there by the central location staff who may not even be on that floor.

Rj

I work in a hi-acuity hospital. Patients who require NTG drips are not allowed on the general cardiac telemtry but must be placed in a "CLUSTER" or stepdown from CCU which is only allowed a 1:4 ratio, however in our opinion it should really only be 1:3. NTG can be a powerful drug, if you are using low rates what is the point? Longer acting PO nitrates can do that. Higher than 50 mics requires CCU. You should also have B/P parameters, especially as many of these patients are already on Beta-blockers, ace-inhibitors which also lower B/P

Our unit will start admitting patients on nitroglycerin drips. It is a telemetry unit with a ratio or 1:5 patients. What do you think about this?

The problem I have is the manner in which decisions of this type are made. In the vast majority of cases such changes reflect community standards rather than any evidence based practice or outcomes analysis. And community staffing practices are primarily reflective of budgetary as opposed to clinical considerations.

Individuals who do not have to practice under the conditions they decree over coffee and donuts give opinions as to what is safe as though their opinions carry the weight of evidence. So they make up arbitrary rules as they go along (If the patient requires 50 MCG of NTG they go to the Unit, if the patient requires more than 2 titrations during a shift they must transfer, if the patient requires upward titration they must be in the unit but if you are titrating downward they can stay etc etc.) The decisions are made in a vacuum without regard to the overall impact several such patients can have on an individual nurse's overall workload and the workload of the unit as a whole. In their world stable patients remain so....until of course, they crash and burn so obviously that they have to be rushed to the unit or they die.

Sadly, we have gradually bought into this management speak; we think we "know" the answers to questions such as this one, but do we really? If so, how would one explain the burnout rate of floor nurses, the large numbers of serious errors medication and otherwise, the failures to rescue, the recent outcry for emergency response teams, etc. Just a little food for thought if I may.

This is what most post-cath and post CABG units do. We are talking stable patients here, not in need of more than very little titration (and usually downward at that).

When we transfer out post open heart to the step-down the only thing they go with is a monitor and maybe a triple lumen and feeding tube (if they've been around a while).

Rarely, rarely, rarely do we send out anyone on a dopa drip and if we do it's never more than 3 mcgs. If we send this patient out it's more than likely because we need the bed.

We pull the art line, chest tube, foley, any large central lines like an introducer or swan. Usually these folks transfer with just a couple large bore peripheral lines. Valves go with their av wires.

When we send them out, we send them out for good. We don't want them coming back.

at my facility the "stable" tele floor (32 beds) and the step down (14 beds) both take pts on ntg, we titrate up and down as necessary to 200 mcg. our ratio is 1:4 24/7 on step down and up to 1:5-7 noc on the 32 bed floor. ntg alone is not a reason for icu, unless the pt is unstable/having a large mi. but the non-tele floors in my facility are not allowed to have ntg gtts. 1:4 or 1:5 sounds like a reasonable assignment fro ntg gtts, they just need continuous bp monitoring if you are titrating and watch out for hypotension after you give the cardiac meds...