titrating cardizem

RN5000 · Mar 17, 2006

Our TCU floor does not titrated cardizem gtts. What is involved with the titration of a drip. It would be nice if we could and cut down on patient expense. If the cardizem needs to be titrated, they are to be transferred to CCU or ICU. Thanks in advance.

My tele unit has a similar policy. We do hang cardizem, but it has to be ordered at a specific rate with specific parameters. If the doc wants it titrated, basically meaning the pt will be very closely monitored and the drip will be adjusted according, at least somewhat, to the nurses judgement, they must be transferred to ICU. On the floor we often dont have time, due to hight pt load, to monitor a titrated drip closely enough.

UM Review RN, ASN, RN · Mar 17, 2006

Our TCU floor does not titrated cardizem gtts. What is involved with the titration of a drip. It would be nice if we could and cut down on patient expense. If the cardizem needs to be titrated, they are to be transferred to CCU or ICU. Thanks in advance.

Our patients on titrated Cardizem gtts are transferred. We keep the ones who have parameters but no titration involved.

I have to admit I'm a bit surprised that you're volunteering to keep those titrated Cardizem drip patients.

If y'all have enough staff to keep that close an eye on one patient, I'd like to come work on your floor.

~Anne~ · Mar 17, 2006

Our TCU floor does not titrated cardizem gtts. What is involved with the titration of a drip. It would be nice if we could and cut down on patient expense. If the cardizem needs to be titrated, they are to be transferred to CCU or ICU. Thanks in advance.

Its really not hard to titrate a cardizem gtt . Our tele unit does not transer pts on cardizem gtts. We start them , titrate them ,and DC them . Its a lot of nursing judgement on our part and calling the docs comes after the fact. They write the orders ,but its not always clear , so we do have a standing policy on titrating ... and like i said alot is nursing judgement, but you get used to it just like everything else they throw at us!

neneRN, BSN, RN · Mar 18, 2006

We send our pts on titrated Cardizem to the tele floors; I have NEVER seen a pt sent to ICU for only that reason.

burn out · Mar 18, 2006

I don't understand how you can just hang a cardizem drip and do nothing with it after that. You have to continually monitor and assess to make sure that 1. It is working effectively and bringing down the heart rate or 2. It is working too effectively and lowereing the heart rate tooo much. In either case action needs to be taken no matter where the patient is at.

~Anne~ · Mar 19, 2006

I don't understand how you can just hang a cardizem drip and do nothing with it after that. You have to continually monitor and assess to make sure that 1. It is working effectively and bringing down the heart rate or 2. It is working too effectively and lowereing the heart rate tooo much. In either case action needs to be taken no matter where the patient is at.

We do moniter it after its hung. We have a tech that watches the moniters 24/7 so if there are any changes they call us and let us know right away,

and then we can adjust the gtt. We also have to assess the BP the first hour after its hung .

RN34TX · Mar 19, 2006

I still occasionally float to tele from ICU and this has been an issue for us as well.

The docs are always trying to fight our "no titrated drips" policy for the tele unit. It's hard for them because the tele unit is often staffed with floats from ICU and they see us doing it there all of the time, so why not do it on tele as well, is what they are thinking.

I understand where the OP is coming from, it truely can seem like a wasted ICU bed when that is the only reason to transfer them to ICU.

I'm not trying to say that tele nurses aren't capable of managing a titrated cardizem gtt, as one person pointed out that it's not difficult to do.

That's not the issue for me.

I flat out refuse to do it whenever I float to tele regardless of whether or not I do it in ICU everyday because I just plain have too many patients to care for on tele and I just don't think it's safe to give a nurse 6 patients and expect them to manage a titrated cardizem gtt.

I would discourage anyone from trying to advocate or push for titrated drips on tele, it's not in our best interest as nurses and I don't think it is for the patient either.

I realize that it could free up some ICU beds but staffing on tele units can be scary enough as it is.

It's just one more thing that could go wrong on a busy shift on tele and all of the fingers get pointed at one over-burdoned nurse who "wasn't monitoring his/her patient closely enough."

Tele nurses, IMHO, get enough real "iffy" ICU-would-be or should-be patients as it is.

Nightrn16 · Mar 19, 2006

The floor I work on, a tele floor, we hang, titrate, and manage a cardieziem drip, all while looking after normally 9 patients total. We have our HUC's watch the monitor's. It's never left unattended. Normally we tell them when we start them on a drip, or give anything that could affect a heart rate (like pushing lopressor), and they let us know if something happens. If for whatever reason, we need to put them on a frequent BP's, we throw a dynamap on them, and try to check in on them when it should be going off. Cardiziem is actually one of our very frequent drugs, so I guess we tend not to think too much about it. (We also do dopamine, dobutamine, nitro, heparin, integrillin, amniodarone, and various other critical drips.)

shadowflightnurse · Mar 19, 2006

I have worked at many different hospitals, some do not allow any vasoactive drips at all on tele floors. Most will allow them as long as they are not being titrated. For example will will have a chest pain, start on NTG, titrate in the ED until at the effective dose, then they can go to tele. If it is requiring frequent titration, they go to the unit or step-down ( if there is one ). Alot of the tele floors now are way understaffed, yet are getting pts with much higher acuity levels. We are all caught between a rock and a hard place in these situations. When the solution is found, please let me know. :banghead:

stn2003, RN · Mar 20, 2006

On my SDU we titrate it on the floor. The other day I had two pts on it that I was keeping track of, luckily they were in the same room because I was in and out so much. One was too tachy, the other bradying down lol. The only thing that bugs me about cardizem is when a doc initially orders it but doesn't give the order to titrate it up to 20 for a HR> than whatever, or wean it off etc, because then you have to call them all night to get the rate changed. Most docs will just give you the parameters and orders to titrate right off the bat though to save them a barrage of phone calls about the cardizem throughout the night. Drips definately have a potential to be a PIA when you are trying to manage a busy team of nine : / I personally try to avoid them : ) Another drip I like to keep clear of is Dopamine. I am paranoid about the site and check it super often for infiltration, because I have seen that happen twice and then you need to call for the Regitine injection etc. and document up one side and down the other plus start another IV and restart the drip, and it is just a time eater!

neneRN, BSN, RN · Mar 20, 2006

Our hospital uses a preprinted Cardizem protocol which includes parameters for titrating/holding/calling MD. Pretty much anyone on Cardizem just has the protocol ordered.