Problem with weights in the ER

**canoehead, BSN, RN** · Oct 18, 2009

At our hospital there is an upper limit to start the anticoagulants at- so the max would be about 200lb, and then we titrate up from there based on lab results.

For pressors and other drips we titrate to results in the ED. so the weight doesn't have anything to do with the amount except perhaps the initial starting dose, and even then we start low and go up based on results. So we may report to you the wrong mcg/kg/min, but the effect is what we wanted...and the weight you get in the ICU doesn't change the amount infusing on the pump.

So the wrong weight doesn't mean a whole lot when you are titrating to results...the slowest turnaround time for labs would be 8hours for a heparin gtt, after that the weight doesn't matter. Does this make sense?

uptoRNin04 · Oct 18, 2009

We titrate to results as well in the unit. The major problem has been with heparin. The inital bolus and then the gtt rate. We also have a max, thank goodness, or who knows how high someone may go. The major problem has been with a small person and the overestimate of weight as much as 100 lbs. They have received a very large bolus and we have follow up ptt's that are way too high. How does your ER come up with an estimated weight?

flygirl43 · Oct 18, 2009

what about bed scales

uptoRNin04 · Oct 19, 2009

seems they don't use bed scales in our ER.

morte, LPN, LVN · Oct 19, 2009

We titrate to results as well in the unit. The major problem has been with heparin. The inital bolus and then the gtt rate. We also have a max, thank goodness, or who knows how high someone may go. The major problem has been with a small person and the overestimate of weight as much as 100 lbs. They have received a very large bolus and we have follow up ptt's that are way too high. How does your ER come up with an estimated weight?

i would bet you that it isnt a wt issue, but setting the pumps for pounds instead of kilos

**canoehead, BSN, RN** · Oct 20, 2009

We don't have scales for anyone that can't stand. Meds that require a weight generally are used for sicker patients, so we rarely know the weight. Generally estimating is a group vote. We're usually within 20lb of each other, so haven't been very far off.

I used to work at a hospital that asked the patients their weight as part of the triage process. Amazing how low people would guess compared to their actual weight. Whenever someone guessed more than 50lb less than I thought they were asked to get on the scale.

pawashrn · Jan 2, 2010

Any drug, when assuming anything, should be started low and titrated for an acceptable response. The more intense titrating for the longer term is made in a controlled enviroment(ICU).ER's are not there to fix the problem, only to identify immediate cause/ stablize/transfer