Re: Weight based critical drips

[Florence NightinFAIL, BSN, RN]

I'm a PACU nurse that has been redeployed to ICU a few times past 3 months. I'm wondering for the weight based infusions, what weight do you guys enter and how often do you update? Actual weight, ideal weight or lean body weight? So far, I've taken over patients who already had drips running so I didn't have to enter a weight but I'm wondering if you guys change the weight daily based on their actual weight? I know there would be accuracy issues with using actual weight with patients that are third spacing/edamatous but I haven't had this addressed yet. 

[LovingLife123]

We use admission weight.  

[Florence NightinFAIL, BSN, RN]

3 hours ago, LovingLife123 said:

We use admission weight.  

Does the weight not change for those patients who are in ICU for weeks or months? Since they are getting tube feeds, their weight gain would be due to more than edema. 

[LovingLife123]

Tube feeds don’t cause third spacing and edema.  An excess amount of IV fluids will which is sometimes indicated depending on the patient.  We still base our weight based medication on initial weight.  The excess weight is a temporary thing and we usually end up giving a few doses Lasix and they pee that fluid off quickly.  We don’t readjust pump weight daily.  

[JBMmom, MSN, NP]

We have had this discussion many times in our unit. Per pharmacy, any new weight based drips are ordered based on the daily weights entered every morning by night shift. The order for that medication doesn't change throughout the hospitalization.  Our pumps are programmed by individual channel, so you can have multiple weight based drugs with different weights. We did recently have a patient who lost over 100 lbs during his stay in our ICU, so I guess in that case it made sense in some ways. 

[marienm, RN, CCRN]

My hospital uses whatever weight the provider chooses (admission weight or current weight).  We don't typically update these orders daily...our official policy says it should be changed if the patient has a 10% or more change in their weight. We used to focus a lot on trying to get the providers to only use the dry weight and to "fix" the weight in the order but honestly it seems to be a losing battle!  Like another poster, our pumps have the weight programmed by each channel and they have to match the order exactly so that the pump can communicate with the EMR.

I take comfort in the fact that most of the gtts that ICU nurses titrate are titrated to a measurable response (pain scale, sedation, blood pressure, HR, coags).  So even if the weight isn't exact you will adjust your titration based on the response. A RASS of -2 is -2 even if the propofol order is based on a 70kg weight for a patient who now weighs 80kg.  If your max dose for that weight isn't enough to sedate the patient then you probably need a different drug rather than worrying about correcting the ordered weight so you could give a tiny bit more.  Obviously there is much less wiggle room with peds (I only work with adults) and it a patient has truly had a significant and rapid weight change (total leg amputation) then it's worth pursuing correcting the dosage weight in that circumstance.  

[JBMmom, MSN, NP]

On 5/12/2021 at 2:08 AM, marienm, RN, CCRN said:

I take comfort in the fact that most of the gtts that ICU nurses titrate are titrated to a measurable response (pain scale, sedation, blood pressure, HR, coags).

Excellent point. Despite the fact that initial doses might be based on weight, almost all titratable drips- pressors, heparin, cardiac medications, sedatives and analgesics, all have endpoints unaffected by weight or weight changes. 

[Florence NightinFAIL, BSN, RN]

Thanks for the responses all.

Marienm, that makes so much sense. Thank you. 

[0.9%NormalSarah, BSN, RN]

Also just want to toss in here that some drips like levophed can be run weight-based or not. My current hospital runs it as mcg/min, but my old place ran it as mcg/kg/min, so there can be a difference. And while I was used to the latter way until I changed jobs, it still works out because we do titrate to effect. Also pointing out some drips are run by ideal weight, like ketamine, which should not change.