Proper Monitoring for IV Push Lopressor

[RN4U2009]

My coworker and I are both new grad nurses and we are doing a project on the proper administration of IV push Lopressor. We have researched the protocols for giving the drug IV push and have found that the literature states that for acute cardiac treatment that both ECG and BP monitoring are required when pushing this drug IV. In our facility, doctors are the only ones who are able to push this drug and we have noticed that they are solely using the dynamap w/SPO2 sensor as a means of monitoring. We would like to find out what the correct protocol for pushing this drug is; if it is necessary to have an ECG (which we think it is); if the dynamap is a reliable source of monitoring; and practices in other hospitals. If you could give us some feedback, it would be greatly appreciated.

[rghbsn, BSN, RN]

I wouldn't push it if they weren't on a monitor. All you can do is suggest it, if they're pushing it, it's out of your hands.

[Virgo_RN, BSN, RN]

Because metoprolol reduces conduction velocity through the AV node, it can cause 1st, 2nd, or 3rd degree heart block. This is why ECG monitoring is important when giving this medication. Without ECG monitoring, your first clue to any of these would be bradycardia and possibly irregular rhythm. If the Dynamaps your doctors are using have the pulse oximeters built in, then they could see the patient's pulse and whether it is regular using the pulse ox, and monitor the BP using the automated BP cuff. I would imagine that they are also auscultating heart sounds during the process as well. If the pulse were to slow to a concerning level and/or become irregular, then the physician could obtain a 12 lead EKG.

Now, is this ideal? No, and as a nurse, I would be in deep doo-doo if I were to practice this way.....however, I can't speak to the standards of practice to which the physicians at your facility practice.