Neuromuscular Blockade protocol

ckh23, BSN, RN · Feb 13, 2012

Is this for anything in particular? In our unit, if we have to paralyze someone we use vecuronium. We use a bolus and then place them on a drip. We then titrate that drip based on TOF. These patients are always sedated. How involved is your protocol?

valj · Feb 16, 2012

Our neuromuscular blockade protocol is very labor intensive and subject to errors. Trying to find user friendly TOF (train of four) protocol. Please hel
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We use Norcuron too, but we have to bolus with 0.1 mg/kg over 1 minute; increase of 0.025 mg/kg till 1-2 twitches, then start maintainence dose of 1.33 mcg/kg with addidtional boluses of 0.33 mcg/kg if > 1-2 twitches after maintainence dose started. Looking for a simmplier bolus regimen...we usually end up titrating to effect....but I need to change our protocol and looking for a better one.. Thanks!!!

AnnoyedNurse · Aug 15, 2017

I don't believe bolus' are reccomended after the initial bonus. Baseline TOF prior to paralysis, bolus of physician preferred agent, start continuous infusion of paralytic agent, check TOF q15 until TOF is 2/4 twitches then q1 hour TOF. Most order sets should include lacrilube for the eyes, and sedation of RASS of -4 and a BIS of 35-45 BEFORE the administration of the paralytic bolus. Paralysis should be discontinued within 48 hours to prevent patient from losing respiratory drive requiring longer vent days leading to poorer outcomes. Overparalysis may also lead to decreased drive after agent us discontinued requiring longer vent days and poorer outcomes. Hence, bolus' after the initial is no bueno. I'm going to try and find my previous hospitals protocol in my closet and if I do I can post it here!