Reopro Kit

[Nurse_Ratched]

Ran a fairly smooth STEMI alert the other night in a pretty chaotic environment, what stumped me the most was Reopro. The patient was well over 80 kilos so weight-based dosing was maxed out, we just didn't see where the max infusion rate was, and kept trying to calculate it out. We do not give it all that often, so it's certainly a high-risk, low-volume kind of skill. Does anyone have any tips or tricks for improving the process? I'm thinking of putting together a Reopro kit, that would include a laminated card about Repro from our Critical Care Drip Book, filters and syringes to draw up the drug, a 250mL bag of NSS and a Medication Added Label, and the IV pump tubing. All this would be stored in a plastic ziplock bag in the med room (where all these items are stored already, just scattered in bins) and the expectation would be that the last one to use would replenish the items. We have a STEMI kit, which is basically a small tackle box with all the necessary meds (but not Reopro or Heparin).

We are a community hospital and all STEMIs are transferred approximately 30-40 minutes north to the cath lab for intervention.

[Altra, BSN, RN]

I admittedly have limited familiarity with Abciximab administration as I have worked mostly in hospitals with in-house PCI capability. But the bolus dosing here ReoPro (Abciximab) Drug Information: Indications, Dosage and How Supplied - Prescribing Information at RxList states 0.25mg/kg, without a maximum. The following page notes that no occurrences of overdosage have been noted. Does your hospital's pharmacy/policy say something different?

[Anna Flaxis, BSN, RN]

I love kits- as long as everyone takes the necessity of replenishing seriously and this actually gets done.

[Nurse_Ratched]

We gave the 0.25 mg/kg bolus (136kg), but also had to start the continuous infusion of 0.125 mcg/kg/min. The drug guide maxed out at 10 mcg/min but our pharmacy guidelines maxed out at 17 mcg/min.

[Nurse_Ratched]

Now that I wrote that, I'll actually have to double-check the way the order is written when I get back to work. We set the pump to 17 mL/hr which comes out to 10 mcg/min. But I think the order may have been written start infusion 0.125mcg/kg/min up to a max of 17 mcg/min, instead of 17 mL/hr.