OK to push Dig IV without a monitor?

Specialties CCU

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Specializes in 5.5 years Long Term Care, 0.5 years ER.

Is it safe to push Digoxin via IV if the patient is not on the monitor?

I work at a skilled nursing facility. Coming back on from the weekend I heard in report that an MD ordered IV digoxin on one of the residents on the unit where I work. Scenario: the resident is a no intubate, no CPR but may send to the ER (our code status where I work is weird with a lot of gray areas I know).

When I heard this my first gut feeling on hearing those would be to question the MD about my reservations about pushing dig IV w/o a monitor. I've done half a year in ER but I got out because it was too stressful for me to handle. Nevertheless I would have questioned the doc on that one.

Just bouncing this scenario off wondering what you guys think.

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Specializes in LTAC, Telemetry, Thoracic Surgery, ED.

I am always of the opinion do what you need to do to treat the pt but according to policy....if there is no policy at your facility on pushing dig then call someone above you to make sure it's OK. Second...what was the DIG for? If there was no monitor how did the doc know what the rhythm was or what he was treating? If he could manually assess to determine the rhythm then he could manually monitor the effects theoretically (sp?)

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Specializes in Cardiac, Med-Surg, ICU.
Is it safe to push Digoxin via IV if the patient is not on the monitor?

I work at a skilled nursing facility. Coming back on from the weekend I heard in report that an MD ordered IV digoxin on one of the residents on the unit where I work. Scenario: the resident is a no intubate, no CPR but may send to the ER (our code status where I work is weird with a lot of gray areas I know).

When I heard this my first gut feeling on hearing those would be to question the MD about my reservations about pushing dig IV w/o a monitor. I've done half a year in ER but I got out because it was too stressful for me to handle. Nevertheless I would have questioned the doc on that one.

Just bouncing this scenario off wondering what you guys think.

I have seen Digoxin po switched to IV form for patients that were NPO, just for maintenance purposes, however, this was in a hospital setting. What is the reason the patient needs IV Dig? Is it a loading dose? A one time dose in an attempt to convert A-fib? Are there any written progress notes available to discern the reason? I would definitely question the need to give IV Digoxin in an LTC setting if it can feasibly be given po.

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Specializes in Utilization Management.
I have seen Digoxin po switched to IV form for patients that were NPO, just for maintenance purposes, however, this was in a hospital setting. What is the reason the patient needs IV Dig? Is it a loading dose? A one time dose in an attempt to convert A-fib? Are there any written progress notes available to discern the reason? I would definitely question the need to give IV Digoxin in an LTC setting if it can feasibly be given po.

I agree, and while you're at it, make sure the patient gets regular dig levels added on to her lab regimen. ;)

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Specializes in Cardiac Telemetry, ED.
I agree, and while you're at it, make sure the patient gets regular dig levels added on to her lab regimen. ;)

And K+.

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Specializes in Utilization Management.

:yeahthat: Thanks, Nancy. I forgot that one.

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