Use of IV push antihypertensives on the med surg unit

[will robinson]

Hello everybody. This is my first post. This looks like a good site for info. My hospital is currently researching use of IV push meds for hypertenison on the med surg units. Anyone out there with what your hospital allows or p/p would be most helpful. Our units use some IV push meds now, however, with the advent of some of the newer drugs the MD's are ordering meds that can only be given on monitored units. You can see that this could cause some problems. Thanks to all who read and respond to this.

[MAISY, RN-ER, BSN, RN]

What medications? The medication's requirements are what will drive ability to push, anything that will change bp that much must be monitored! We push alot of different meds in ER -our patients are monitored, how will you see change or adverse effect?

Maisy

[patwil73]

At our facility we can push labetolol or metoprolol on the floors. We will take the BP/HR prior to pushing and 5 minutes after (or should). If we have to push these medications frequently that would call for a tranfer as the level of care is exceeding that found on the floors - however, pushing a couple of times a shift would not.

Although our policy does not call for it, I strongly feel that you should have tele if pushing metoprolol at least.

Hope that helps

Pat

[shellsgogreen]

in the hospital where i work, we can't push antihypertensives on my unit - i'm on a monitored floor, which means there are orders for cardizem and lopressor etc but the md is the one who will push it (or an icu/ er nurse)

[BinkieRN, BSN, RN]

At our facility we can push labetolol or metoprolol on the floors. We will take the BP/HR prior to pushing and 5 minutes after (or should). If we have to push these medications frequently that would call for a tranfer as the level of care is exceeding that found on the floors - however, pushing a couple of times a shift would not.

Although our policy does not call for it, I strongly feel that you should have tele if pushing metoprolol at least.

Hope that helps

Pat

We push metoprolol 5mg IV but only on Telemetry patients and one nurse must push and another nurse must watch the monitor. When the patients go to CT for a CTA they get up to 50 mg of metoprolol IV prior to the CT. The CT nurses give it. Me...no way! The need to get the HR as close to 60 as possible

[Bocephus71RN-BSN, BSN, RN]

as said before when pushing metoprolol one nurse should push the med and one nurse should be watching the telemetry monitor for lengthening PR interval causing a AV block and of course HR. Labetolol is not as strong of Beta blocker but the pt. should still be on telemetry.

[RheatherN, ASN, RN, EMT-P]

we have a few that we push on my floor, meto/labe and one other that i cant think of cuz i have never done it. we have a policy that the pt has to be on tele. i know there are acceptions to the rule as always, but if they are there for those types of probs and any anticipation of push meds, we will have them on tele anyhow.

hth!

-H-

[Blee O'Myacin, BSN, RN]

I've never been comfortable with pushing antihypertensives with remote tele. I want to see the rhythm for myself. (I have ICU and ER experience mostly, with floating to floors as necessary).

So unless the patient is hooked up to a bedside monitor or a 12 lead, then I'd be questioning the order and whether the patient is receiving the appropriate level of care with the MD. (ie - remote tele vs. PCU).

Blee

[MAISY, RN-ER, BSN, RN]

I've never been comfortable with pushing antihypertensives with remote tele. I want to see the rhythm for myself. (I have ICU and ER experience mostly, with floating to floors as necessary).

So unless the patient is hooked up to a bedside monitor or a 12 lead, then I'd be questioning the order and whether the patient is receiving the appropriate level of care with the MD. (ie - remote tele vs. PCU).

Blee

Definately with you! Only work ER, can't imagine having a patient who needs iv anti htn meds on a non-monitored floor! Even someone with hx of afib, tachy or whatever....so used to having the tools..almost seems irresponsible not to have them. Then again, alot of times we are doing vitals q5, q15, q30 q1hr, q2hrs or whatever....we know that doesn't happen on med surg.

Maisy

[august07]

I work on med-surg and can only push Vasotec. Anything else and the patient has to be on a tele floor.

[will robinson]

Thanks everyone for your input. Most answers were as expected. The use of IV push meds should be on a monitored unit. My opinion as well. Been a Nurse 20 years, 17 in the ER. Again thanks.

[Super Nurse JoshuA]

What states are y'all from?

On my former med-surg floor (also in school) we pushed a wide range of cardiac drugs on the floor (Dig, Vasotec, Lopressor, atropine, various others) even when the patient is not on cardiac monitoring. Only LPN's were not allowed to push cardiac medicines. We also pushed mannitol, versed, fentenyl although the last two in rarer situations. . . however no one in the hospital is allowed to push phenergan!!! :icon_roll