IvesRN

The same thing happened to us when jchao came and surveyed our ICU. What we did is build into our titration gtt of Levophed is 8mg/250ml with maximum of 40mcg/min and to initiate at 5mcg/min and increase by 5mcg/min every 5 minutes with goal of MAP >65 or whatever the intensivist prefers. This keeps you compliant, but we all know it is extremely difficult and almost impractical to continuously have the intensivist change the parameters as the patient sensitivity changes. It's a hairy situation when jchao starts dipping their fingers in everything. When I started in ICU 3 years ago, this was not an issue. But seems lately it has become a focus of jchao with drip titrations.

Hello, I am right there with you and have been looking to do what you just said above. Like you, I have the slightest of an idea of where to start. I will be interested to see what this thread comes up with!

We have open visitation and one person can stay overnight. It does not hinder my nursing care to my patient. I inform the family members if there are many, that when I enter the room I am see to care for their loved one. This means I need to be able to get on both sides of the bed, the iv pumps, the ventilator and the commode. I find when I tell families this they are very respectful of this and will be out of my way. The only thing I don't like about our open visitation is sometimes people will come in and out of patient rooms all night long and this can make it very difficult for the patient to sleep! That's my only concern with open visitation. I find that family members are more informed and ask more questions when they watch you do an assessment because they want to know what it means! Obviously family cannot be around when private care is provided. We are blessed in having very large rooms and able to pull a curtain to maintain privacy with family still in the room!

I have seen this as well as previous people pointed out usually related to ARD's. Low Vt, watch the peep, watch their blood pressure, try to minimize barotrauma. I wish our ICU would prone patients, we need new beds to do this properly...

Thank you very much for your response and information regarding this sensitive topic for us nurses.

In our 24 bed ICU level 2 trauma center we as ICU nurses do the CRRT. The patient is a 1:1 as long as the CRRT is ordered. The dialysis nurse does all the conventional hemodialysis but we do the CRRT.

Thank you thth21. I am finding a lot of MICU/SICU's practice this where they have an extra RN that does not have an assignment and can then cover staff while they go to lunch or on road trips with their patient. I personally like this idea, but whether my director will justify the staff or not is another story. The only thing I can do is present it to him and see what happens. Thank you so very much for your feedback!

ICUPrincessNurse thank you for the input. I like the idea of having resources nurses on the unit that don't have patients and are able to help with watching others patients and assisting with things. Thanks again.

Good thoughts about the vasopressin but in septic patient in the acute phase diuretics are almost always contraindicated because intravascular the patient is very volume depleted already because of the leaky cappillaries and fluid leaking into the extra vascular areas. This is why the patient is so hypotensive in the acute stage.

First thing with sepsis is find a cause, give antibiotics, if patient is hypotension needs more than 1 liter of fluid resuscitation. Normally around 3 liters is better depending in patient weight. If the patient continues to be hypotension then you can start vasopressors and Levophed is pressor of choice with sepsis. I wouldn't treat that temp unless as previously noted if the patient was to tachycardiac and loosing fluids from perspiration or the patient was on immunosuppressive meds....this would lead that a temp of 101 would be more significant in that setting. Definitely need to watch for "shocky liver" in relation to Tylenol. I don't like vasopressin all it does is allow for a lower dose of Levophed for hypotension.....dopamine is not a good idea in sepsis setting because of increase myocardial oxygen demand because if the effects of dopamine on the heart and especially the heart rate...in the setting of fever and dopamine have a high risk of extreme tachycardia. It is very important to pan culture the patient, start antibiotics immediately and fluid resuscitation and even in heart failure the fluids are very important and if nothing else just intubate the patient because the fluids are more important.

Thank you sapphire18. Out acuity is usually pretty high and most patients do not get OOB. However we are getting more and more telemetry overflow during low census in the ICU and high census on the telemetry floors. I will take your advice and see what we can do. Thank you so very much. I think our increase in falls is in direct correlation with the increased number of telemetry patients we are seeing who are very ambulatory and so forth.

This thread is about what do ICU's do for lunch breaks, how do you determine when who goes and who covers your patients. I work in a 24 bed MICU and we have a charge nurse who does not take patients, our staffing is 2:1 for the most part with frequent 1:1 patients. I was asked by my director to look at revamping our lunch break coverage due to an increase in falls on our unit from time to time. Currently we have 45 minute lunch and we assign a "break buddy" whom you report off to when you are leaving the unit for anything such as lunch or transporting a patient to ct-scan. This "buddy" then watches your patients while you eat. This works well but there really are too many nurses off the floor at once during peak lunch time. I have come up with a few possibilities with my colleagues working with me on the floor but I am looking to see what other ICU's do across the nation. I thought maybe I could learn something and get some ideas. Thank you in advance. Hope to hear from you!