titrating drips and hemodynamics

nowplayingEDRN · Aug 31, 2003

Springhouse makes some excellent pocket guides.....You can also go to Barnes and Noble or Amazon on line and run a search on this particular reference. NNCC makes a sweet little pocket reference for critical care nurses. You can find their stuff at: http://www.nnccusa.com

Also, if you email me, I have on my hard drive in adobe acrobat format, a criticale care reference that you might be interested in......

Hope that this helps you. :)

Christie

susi_q · Sep 3, 2003

Not specific to titrating either ... but when I am precepting someone in our unit I refer them to icufaqs.org - has a ton of information. Not all stuffy, either. (Be alittle careful, every now and then not exactly correct - but a great way of explaining)

hoolahan, ASN, RN · Sep 3, 2003

To titrate drips, you need to understand the halflife of a drug. Most IV drugs have very short half-lives, which is why the drug has to be given via continuous infusion as opposed to taking a po med q hour. You also must understand the actions of the drug.

Example. Dobutamine is a positive inotrope, so would be a good drug to use for someone with a low cardiac output. But it also cause vasodilatation, so if the person's afterload or PVR/I was really below normal, it may make the pt hpyotensive. So, maybe in that case Dopamine would make a better choice, since it can have some alpha effects and cause vasoconstriction.

Have you attended any seminars?? I find I learn the best in a seminar, outside of the noise and stress of the unit.

You have a 32 bed ICU??? What is the nurse : pt ratio?? Has your hospital sent you to a critical care class? We had advanced hemodynamics calsses we needed to take in order to move up the clinical ladder.

passing thru · Sep 3, 2003

Good post, Hoolihan.... I seldom hear of hospitals sending their CC nurses to classes these days...

I tell all my ICU pals, "you can't learn it all in the unit."

I think it is disgraceful that new ICU nurses are not getting the classes and experience we had....

nowplayingEDRN · Sep 3, 2003

Good points, Hoolahan. There is definitely so much more to titrations and hemodynamics. the mechanics of how a drug works on the body as well as the mechanism that the body uses to metabolize the drug all play a part in what and why we titrate certain drugs.

Some community colleges that are very diverse occasionally offer a basic critical care class as well as basic rhythm interpretation. And there is a certificate upon successful completion. There are also many seminars offered at various times through out the country on critical care skills. Laura Gasparis not only does CCRN review classes but she has an enhancing your critical care skills seminar. She is very knowledgable and does an excellent presentation with great tips for remembering things. I would have to do a search on where to find some of these seminars though as I can not remember off the top of my head.

And you are quite right passing thru......you can not learn everything in the unit, education is a big key to ensuring knowledgable staff. The only folks that send their unit nurses to classes in the Army but they only send their active duty nurses to an ICU course. If they feel generous, they will approve the civilian nurses to go to seminars that are specific to the area they work in.

New CCU RN · Sep 3, 2003

I have to disagree about units not sending their employees to classes......when I was a new grad I was sent to many ICU classes, and even now I am scheduled to go to two next month for more advanced topics. I think it all depends on the hospital, however, many of the seasoned nurses say we go to more classes than they ever did....

However, the best learning is what you do on your own....... get some good references (even a CCRN prep book b/c it covers everything) and study away....... also, make yourself a little card of pressors and other common gtts you hang... I used to always carry mine with me...... have the concentration, the titration, the hemodynamic affects, and any other nursing considerations on it...any CC text will have that..... then just run it by your pharmacy for accuracy and also a senior nurse on your unit.

Good luck

XIGRIS · Sep 3, 2003

On titrating drips:

I agree that you have to know the drug's half-life and interactions. It also takes practice and experience to be able to be "competent" in titraing these agents. Sometimes, it make sit easier if you have a PA cath hence, you can monitor hemodynamics with the titration. Most vasopressors, when you titrate them you immediately see the results however, there are few drugs ( eg Primacor ) which takes 4-6 hours for toyou the see its effects. The example between DB and DA was good. See, you have the see the entre picture of the patient. You need to understand the patient. Hence, we always hear nurses say, " you need to treat the patient not the numbers."

On hemodynamics:

I think it is best to attend a class. Some hospiatls offer a critical care course for nurses. You might want to attend that class. I would love to teach you hemodynamics however I am from Texas. (Grins). Just last month I taught the class ( have been teachin it since 1997 ) and I can teach you the "tricks" of the trade.

Once you understand hemodynamics, titrating drips comes easy.

passing thru · Sep 6, 2003

Xigris:

I think it would be outstanding if you taught your hemodynamics class right here on the Allnurses BB.

If not the whole class, why not post a few hemodynamic correlations each week, a few tips to assist everyone?

We never stop learning.

Personally, I love to hear how other nurses do things.

tsgarman, RN · Sep 6, 2003

I agree with passing thru. That sounds like a great idea! Don't know how much trouble that would be to do it though.

Just a thought.

nowplayingEDRN · Sep 6, 2003

IXGRIS.....

I am with passing thru on thinking it would be a marvelous thing if you posted a few of your tips and or correlations on the BB. What would even be better is if you could do the class online. If you were game, maybe those that are interested could get together and agree on a time that worked best with y ou. I know I would love it, especially as the facility I work in right now never uses swaz and sometimes I never feel like I got to maximize all my critical care skill....so some thing I never got to really master feel like they are going to hell in a hand basket.

I also agree with your last statement...We need to treat the patient, not the numbers or the equipment. Although it is important to know half lifes of druga and how they affect the body not everyone (ok, very few) ever go according to text book, making that statement ever so much more poignant.

krisd · Sep 6, 2003

I have been in your shoes. I think I know what you mean about titrating drips. When I was new I couldn't figure out how the nurses "know" how to titrate them, my preceptors would just change the rates willy-nilly it seemed to me. I kept asking, but how many cc's at a time? Knowing the half life really helps, because then you'll know how soon to look for a change. But it isn't an exact science. When I was new, I titrated very, very slowly, often a cc at a time. As I get more familiar with the drugs, I became less hesitant to make changes. And you can always increase/decrease again as needed.

Kris D

P.S. I bought "Critical Care Made Easy" when I was new and found it a great resource. Have recommended it to all the new nurses I precept.