Question about Nipride

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Specializes in RN- Med/surg.

Ok- I don't have alot of experience with drips (see my vent about work:madface:)

My question is..when you are titrating to a BP..how often do you titrate? Our protocol says to take BP every 5 min while titrating, and that you can titrate up every few minutes.

All shift my pt has been fine. He has a variable blood pressure that is all over the place. I finally got his BP ranging from 110's-130 and left the drip alone. So..question..if I get 1 low BP (not really low..90's) would you titrate back down RIGHT away- or wait for another reading? Right away my charge nurse jumped on me to turn it down...when half an hour ago he was sitting at 125/62.

If I titrate to EVERY BP..I'll be changing it every 5 minutes up and down.

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Specializes in RN- Med/surg.

Anyone? Where are the night nurses?

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Specializes in ER, ICU, Infusion, peds, informatics.

i guess it would depend on where they wanted the bp and why.

if the goal was 110-130, then i probably would have turned it down at the low pressure, i just wouldn't have gone down very much. nipride is pretty powerful.

the more i sit here and think about it, it really does depend on the whole picture. in my mind, titrating anti-hypertensives is more difficult that titrating pressors. when you are trying to increase a bp, and you are shooting for a map of 70, nothing bad is going to happen if the patient is at a map of 80 for a while.

on the other hand, when you are trying to decrease a bp, you need to make sure you maintain a pressure high enough to keep everything perfusing adequately, and you need to make sure you don't bring the pressure down too fast.

right now, there is a patient in my hospital that is in arf, most likely because his bp was transiently low in surgery (and an elective procedure at that).

in general, though, unless the pt has an aortic injury or something like that, you don't see antihypertensives to keep bp that low. (and nipride usually isn't used for aortic injuries since it doesn't help control rate). the post-op vascular surgery patients i'm used to having on nipride usually come with a goal bp of

our nipride protocol is q5min bps as well, which is the cheif reason why i hate it.

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Specializes in RN- Med/surg.

Pt came in with SBP 200. Order is to titrate to keep SBP

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Specializes in ER, ICU, Infusion, peds, informatics.

well, if you think that he "lives" at a sbp of 200 at home, or at least has for a while, then an sbp in the 90s isn't going to perfuse much.

if he is in acute renal failure, then it really isn't going to help get his kidneys perfused enough to recover.

i probaby would have rechecked the bp sooner than 5min, and then turned it down if it was still

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Specializes in RN- Med/surg.

ok- thanks

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Specializes in ICU-CVICU.

I would have retaken it immediately to confirm it really is 92 and titrated accordingly...I wouldn't have waited the 5 minutes.

Nipride is POTENT and requires close attention.

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Specializes in ICU.
I would have retaken it immediately to confirm it really is 92 and titrated accordingly...I wouldn't have waited the 5 minutes.

Nipride is POTENT and requires close attention.

Agreed. It probably would have been nice to have an arterial line too.

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You should have gotten a range from the MD who started the gtt, along with an art line. Nipride is a very potent antihypertensive. But in your situation, I would have immediately recycled the BP and titrated accordingly.

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