Protonix in GI bleed

calivianya, BSN, RN · Feb 28, 2015

Protonix shouldn't affect the BP. My first thought is maybe the patient was getting dehydrated with no IVF running.

Also - it could just be something as basic as the patient being sleepy. If you are only checking vitals once a shift, you don't really know how the patient's BP runs when she's relaxed and sleeping. That pressure's still adequate to perfuse everything - the MAP comes to 67.3 if you do the math, so it's not really low enough to worry about too much. It's possible that 120s/70s was elevated because she was awake and anxious or moving around when that BP was taken. Does she have a history of hypertension or is her BP usually normal?

MunoRN, RN · Feb 28, 2015

It's pretty unlikely the protonix was responsible for the BP change. Any extra few drips they might have gotten is nothing compared to the amount they get with bolus dosing and protonix has no established effect on BP. More likely it was related to the fact that BP is often lower in the night and AM than during the evening, possibly combined with some intravascular volume loss.

I'm a bit confused about your explanation of the lines; it was still dripping so you turned it upside down? That will stop fluid from flowing but only because air will flow instead. I'm not clear why you had to change all the tubing either.

AJJKRN · Feb 28, 2015

Protonix can run concurrent with 0.9, and most ABX can run concurrent with 0.9 as well? Do your pumps not have a drug library you can program? Why wasn't the tubing you were changing not unhooked from the Pt first before changing anyways? Maybe I just need more sleep?

coleeliza · Mar 1, 2015

Pt had no history of HTN. BP's were low in ER, 101/60 to 70 ish. Only history was dementia and UTI. It does make sense that the BP could have been in the 120s systolic at the start of my shift because she was sort of agitated/confused. So it is possible she calmed down quite a bit to show a true BP. Only thing is, the fluids were running my whole shift. It was on PM shift (I work nights) that the fluids weren't running. I literally had to fix everything.

coleeliza · Mar 1, 2015

I'm sure it's pharmacologically OK to run anything with .9, if the Pts medical condition warrants it (no CHF). However, on our floor, any drip (gtt) med must be running by itself, separately, as a primary on its own pump. Hard locked. However, when I took report, this was not the case. So I had to change the secondary tubing to a primary tubing. And the fluids needed to be running somehow... So I had to hang them as a primary and piggyback the antibiotics to them. Which was also not the case when I took report. Only the antibiotic was running as a primary with no fluids (which were ordered and overdue). It was just such a mess. Yes, I should have disconnected the line from the pt first. That's was a mistake. However, our hospital has primary lines with cassettes attached. Anytime you take a primary out of the pump, it should still be clamped (therefore nothing is supposed to be allowed to run unless on a pump). So I figured it would do no harm. Idk if the tubing was warped or something? But noticed the protonix to still be dripping as I took it out of the pump. So weird. Usually it doesn't. I immediately disconnected from the pt.

applesxoranges, BSN, RN · Mar 3, 2015

Maybe tjr tubing did not click all the way?

The patient may have been dehydrated from no fluids plus less agitated/sleeping. What was the heart rate? Was it tachy? (Assuming that she didn't have medications that could hide a tachy heart rate)

in the ER, it is not uncommon to see vitals decrease after they calm down.

ausrnurse · Mar 6, 2015

I'm sure it's pharmacologically OK to run anything with .9, if the Pts medical condition warrants it (no CHF). However, on our floor, any drip (gtt) med must be running by itself, separately, as a primary on its own pump. Hard locked. However, when I took report, this was not the case. So I had to change the secondary tubing to a primary tubing. And the fluids needed to be running somehow... So I had to hang them as a primary and piggyback the antibiotics to them. Which was also not the case when I took report. Only the antibiotic was running as a primary with no fluids (which were ordered and overdue). It was just such a mess. Yes, I should have disconnected the line from the pt first. That's was a mistake. However, our hospital has primary lines with cassettes attached. Anytime you take a primary out of the pump, it should still be clamped (therefore nothing is supposed to be allowed to run unless on a pump). So I figured it would do no harm. Idk if the tubing was warped or something? But noticed the protonix to still be dripping as I took it out of the pump. So weird. Usually it doesn't. I immediately disconnected from the pt.

Now you will remember for next time :) We have similar pumps that should also clamp after the cartridge has been inserted in the machine but I usually try to clamp the line with the roller clamp as well - just in case. I doubt a few drops of pantoprazole had any adverse effect on this pt, I think the hypotension probably had another cause.

IVRUS, BSN, RN · Mar 6, 2015

"I'm sure it's pharmacologically OK to run anything with .9, if the Pts medical condition warrants it (no CHF)."

Coleeliza,

Actually this quote is not correct. Some medications are incompatible with Normal Saline and therefore cannot infuse together, nor can NS be used as a flush before or after that particular medication. It is rare that this happens, but it does happen. Synercid is an antibiotic which only should be hung with D5W and the line flushed with syringes of D5W before and after the IVAB if it is an intermittent infusion.