Titratable gtts

[Stormy]

Our unit is having a war about how to mix various gtts, and we are wondering what everyone else does. We have a lot of inconsistency and new staff are frustrated. For example, to mix a Dopamine gtt., we add 400 mg to 250cc., and then add the drug volume into the fluid volume when programing the pumps (which calculate rates). i.e. 400mg/260cc. For other drugs, we remove the fluid volume from the bag prior to adding the drug. For others, the drug volume is so small, we don't bother taking it into consideration. No wonder they are confused and frustrated. Pharmacy recommends we remove drug volume from the IV bags of all drugs prior to adding the drug. What does everybody else do?

[jcebey]

Yes, you are right. There are inconsistencies with IV drip admixtures. What our Pharmacy has done based on the recommendation of the Pharmacy and Therapeutics Committee was to standardize all the drips. So we get all titratable drips in standard IV concentrations, already premixed from the Pharmacy. Prior to this we usually went by the drug manufacturer's suggestions on drip admixtures. We also have an ICU drug book which the staff uses as reference when in doubt.

[tlmagraw2]

my mantra, so to speak, is when in doubt call the pharmacy....they usually have all the answers when mixing drips. my hospital also has premixed on hand in pyxis.

[mattcastens]

Sounds like you guys are setting up your unit for a huge med error sometime. We get all of our critical drips pre-mixed from pharmacy, and they're very good about getting them to us. In the rare instances when we need to mix our own (usally Nipride), we have a standardized hospital drip formulary that all of the critical care units follow so that all drips are mixed exactly the same.

[tlmagraw2]

matt: my post above should have included the fact that we don't have to mix dopamine, dobutamine, levophed, and tridil; these are always available in pyxis premixed. i do use the pharmacy as a resource for the newer meds that haven't made it into drug books (they take them out of their original boxes and don't leave directions for mixing with them). we have calculation tables and titration tables available from pharmacy in medi-tech, but nothing on how to mix, hence the calls teri

[DethOkay]

It depends upon the hospital your wirking for As a travling nurse I have mixed drugs, used premixed, was not alllowed to mix drugs (only pharmacy could at one hospital) and a combination of all the above. I feel that one shoud be awair of the HOSPITALS policy in mixing drugs. A nurse should be knowledgable to mix the drugs if needed. It can save lives I had a pham tech that incorrectly mixed a aminodrone drip during a code and I was the person who caught it just because the bag looked to "full" ....