I'm a nursing student who just finished my clinical rotation in critical care. I was on the MICU/SICU for the past 3 weeks (and then on CVSU/PCU/PICU/CCU and the ER prior to that).
I finally had the chance to titrate a Levophed drip to maintain the patient's blood pressure above 90 systolic.
When I came on to the floor, his drip was going at 20mL/hr (which I figured was 10.33mcg/min, the concentration of the drug was 31mcg/mL). The nurse I was with told me they titrate pressors by 5's - as in mL/, not my how many mcg/min or mcg/kg/min the patient is receiving. Every time I increased or lowered the dose I made sure to document the patient's blood pressure before and after changing the does as well as the dose the patient is receiving (ex BP 122/84 Levophed @ 5.17mcg/min (10mL/hr). Will continue to monitor). I always made sure to know the dose my patient was receiving (mcg/min mcg/kg/min).
What I want to know is do hospitals generally titrate by mL/hr (such as what I did, increase or decrease the dose by 5mL/hr) or titrate by mcg/min or mcg/kg/min? I know that you should always know the actual dose your patient is receiving because mL/hr doesn't tell you anything!
LoveActually
51 Posts
The only way I'm titrating in mL's is if it's Diltiazem which equals mg's anway.
I ALWAYS titrate mcg/min or mcg/kg/min ALWAYS ALWAYS ALWAYS.
Titrating by 5 mL's may be way too much or not enough depending on the concentration.