Pushing metoprolol IV w/o tele..?

[Joanie49]

I have been a nurse for a year so I am still pretty new... I have always and only pushed metoprolol IV while a patient is on tele. Last night a patient had IV metroprolol scheduled for only B/P control and it was un-needed, his B/P's were like 120's so I called the MD and stated that number one I did not feel comfortable giving the medication w/o tele to monitor and number two the patient did not even need the medication at this time (pt was NPO so IV med's were ordered.) The MD agreed it was unneeded at this time but said that pushing metoptolol is safe w/o tele if metoprolol is only being used for B/P control? I still don't totally trust this which is why I am wondering what other nurses think?

Would you push IV metoprolol for B/P control w/o tele to monitor?

[Newbie_RN17]

I've always done it without tele and just monitored HR and BP before and after.

[Susie2310]

I disagree that it is safe to do so without telemetry monitoring. A family member who was not hypertensive received a single dose of a very small amount of IV Metoprolol during an MI. Their resting bradycardic rhythm with a wide QRS decreased further and I watched their QRS widen further on their room monitor. This put them at increased risk of developing a symptomatic bradycardia and of arresting.

A well known IV drug reference lists a number of contraindications and precautions to observe when giving Metoprolol by the IV route and says that continuous EKG/BP/heart rate monitoring is mandatory for IV Metoprolol.

[Joanie49]

Great thank you! I will take a look in the drug reference guide and state what is in there to the MD next time if another situation comes up!

[MissEm]

Well, what was the heart rate? How did the patient look? What was their history? If your patient was bradycardic with no high blood pressure, you would've been okay withholding the medicine. As for me, I've given it without tele and monitored their heart rate and blood pressure closely. But hey, get a tele if you're worried! No one can blame you for wanting to be as safe as possible.

[NPOaftermidnight, MSN, RN, NP]

Joanie49 said:

I have been a nurse for a year so I am still pretty new... I have always and only pushed metoprolol IV while a patient is on tele. Last night a patient had IV metroprolol scheduled for only B/P control and it was un-needed, his B/P's were like 120's so I called the MD and stated that number one I did not feel comfortable giving the medication w/o tele to monitor and number two the patient did not even need the medication at this time (pt was NPO so IV med's were ordered.) The MD agreed it was unneeded at this time but said that pushing metoptolol is safe w/o tele if metoprolol is only being used for B/P control? I still don't totally trust this which is why I am wondering what other nurses think?

Would you push IV metoprolol for B/P control w/o tele to monitor?

I would absolutely not, regardless of the clinical picture. Your instincts were correct. In my hospital, even in the ICU, we only push metoprolol in an emergency (they must be on the monitor and a provider must push it). Otherwise, we mini bag it and give it over 15 but they ALWAYS have to be on the monitor. We had a patient die a couple years ago as a direct result of pushing metoprolol and this has been our policy ever since. I think it's a little extreme, but at least it's safe and I haven't seen any pts suffer as a result.

Make sure you check your policy, and if it's not specifically addressed bring this up to shared governance or whoever is in charge of these things. If it is, in fact, common practice for metoprolol to be pushed on unmonitored pts in your institution, this is an accident/lawsuit waiting to happen.

Always trust your instincts and never be afraid to say you aren't comfortable with something!

[Anna Flaxis, BSN, RN]

Depends on the clinical picture.

Is this a new medication for the patient, or have they been taking it for a while?

If it's new, I agree that it would be safest to have them on the monitor for at least the first few doses.

If they've been on metoprolol for some time, and it's simply a route change due to NPO status, it is important to avoid abruptly discontinuing the medication, as this can lead to a whole host of problems, such as Acute MI. It would be of great import to make sure they get their dose. If you're not comfortable with an IV push, then mixing it in a mini-bag and infusing over 10 minutes would be a good compromise.