Pushing a Cardizem bolus

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Specializes in Step-down, cardiac.

How slowly do you push a 20 mg Cardizem bolus on a person with afib with RVR? My patient was an elderly woman with stable BP but HR up to 150 BPM. I pushed her Cardizem bolus over four minutes and her BP stayed stable, but within ten minutes, her fragile little vein turned bright red and was extremely painful. She had crappy access to begin with and we couldn't get anything but a 22 gauge in a tiny vein. Lots of saline flushing alleviated her symptoms, and we started her drip at ten ml/hr. I looked it up, and most references say to push over two minutes, but my charge nurse said she takes 20 to 25 minutes for a 20 mg bolus! Is that crazy, or did I do it way too fast?

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Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
How slowly do you push a 20 mg Cardizem bolus on a person with afib with RVR? My patient was an elderly woman with stable BP but HR up to 150 BPM. I pushed her Cardizem bolus over four minutes and her BP stayed stable, but within ten minutes, her fragile little vein turned bright red and was extremely painful. She had crappy access to begin with and we couldn't get anything but a 22 gauge in a tiny vein. Lots of saline flushing alleviated her symptoms, and we started her drip at ten ml/hr. I looked it up, and most references say to push over two minutes, but my charge nurse said she takes 20 to 25 minutes for a 20 mg bolus! Is that crazy, or did I do it way too fast?

Yes 20mg over 20-25 min is crazy and inappropiate. 4 min is too long as well. Seems better access would be in order if one is going to push cardiac meds.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I would make sure you check with you policy and procedure manual for the proper administration

DOSAGE AND ADMINISTRATION

Direct Intravenous Single Injections (Bolus)

The initial dose of Diltiazem Hydrochloride Injection should be 0.25 mg/kg actual body weight as a bolus administered over 2 minutes (20 mg is a reasonable dose for the average patient). If response is inadequate, a second dose may be administered after 15 minutes. The second bolus dose of diltiazem hydrochloride injection should be 0.35 mg/kg actual body weight administered over 2 minutes (25 mg is a reasonable dose for the average patient)DILTIAZEM (CARDIZEM ®) -Â Intravenous (IV) Dilution

A good resource as well.

IV Critical Care Infusion Drip Chart

20 mins? Is WAY too slow and outside the standard.

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Specializes in ED.

Dilute and push over 1 minute.

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Specializes in Step-down, cardiac.

Yes 20mg over 20-25 min is crazy and inappropiate. 4 min is too long as well. Seems better access would be in order if one is going to push cardiac meds.

Thank you! I thought I was going crazy when she said that!! I'm wondering if maybe she was thinking of Primacore. That makes me feel so much better!

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Specializes in Cardiac surgical PCU, moderate sedation.

20 mins? Is WAY too slow and outside the standard. - agree and probably would obtain an order for picc ASAP

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Specializes in Quality, Cardiac Stepdown, MICU.

If you needed to push something that slowly you'd hang it -- like an amio bolus. I'm sorry but it's not humanly possible for me to push something that slowly. I struggle with 2 minutes. The slowest thing I ever push over 2 minutes is heavily diluted Phenergan.

Though I did have a sleepy doc over the phone tell me to push 10 mg Cardizem over 15 minutes. I knew he must have gotten confused w/amio.

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