SNP and Nitro

[GatorRN21]

At our hospital on the post op heart surgery kids, we titrate the nitroprusside first up to 4mcg/kg/min for the systolic BP then once we reach that amount we add on nitroglycerine up to 4mcg/kg/min (not impressed with nitro though). Most kids come out on milrinone, sometimes on a low dose epi. Do other hospitals titrate like this for the BP? What other drips do other hospitals use? Thanks :)

[PICNICRN, BSN, RN]

Thats about what we will do in regards to Nipride and Nitro- about 4 mcg then add Nitro... but with the exception of the heart transplants, our kiddos usually have hypotension- we ususally see Milrinone, Dopa, Dobut, and Epi - then start adding norepi or vasopressin if needed.

[NotReady4PrimeTime, RN]

The only kids we have on nitro are the switches, usually. And it's typically d/c'd within an hour or two of arrival. We use milrinone and nitroprusside for afterload reduction. We've maxed kids on nitroprusside at 6 mcg/kg/min. On rare occasions we've started a labetalol infusion when we can't get the desired results with nitroprusside.

For hypotension we rarely use dopamine on anyone. We use epi, norepi and vasopressin almost exclusively. All of our cardiacs are on milrinone, and some non-cardiacs too. We don't use dobutamine much anymore either. Fluid boluses are always 5 mL/kg of 5% albumin, or PRBCs if they're bleeding.