Vital Sign Frequency with Vasoactive Infusions

[lisa4golf]

Our unit is looking at revising our policy on how frequently vital signs should be taken when titrating vasoactive meds and once they are stable on the med. I have searched the internet but can't seem to find what I am looking for. If any one knows of sites or has a policy you can share. I would help so much.

Thank you in advance.

Lisa

[begalli]

There is no titrating vasoactive drugs anywhere but the ICU's in my facility. The patient almost always has an arterial line and is on a monitor. And so my answer is we continuously monitor vitals.

Sometimes we will get a patient with a AAA or thoracic aneurysm and they are to be medically managed (as oppossed to surgical repair) . They start out in the ICU - maybe without an art line - on nipride and esmolol. They'll also be on a monitor and have a noninvasive cuff that goes off as frequently as every 5 minutes until the bp is within the limits we want on the meds. Then the cuff is programmed to go off every 1/2 hour - hour. PO meds are then introduced and as those kick in the IV meds are weaned off.

We keep very tight control on blood pressures.

edit: oops, sorry. you're looking for a website and here I just blurt out what I do.

[lisa4golf]

Thanks. We are trying to find some info on stopping the q 5min vitals because according to our current policy we do q 5min until hr or bp is in parameters. With Cardizem drips that might take 2 days!

[TennRN2004]

We chart q 15 if we are actively titrating vasoactive medications. Ideally, you have an aline so the few minutes in between you know what a constant bp is. But, if I have one without an aline, there's only been a coupla times I check bp q 10 if I'm still having a hard time keeping VS in range, then usually we can call and get an aline. If patient is stable and we are slowly weaning gtts, then we chart q 30 minutes- 1 hr depending on the patient, and number of gtts.

[suzanne4, RN]

If non-invasive cuff used, I chart every fifteen minutes, unless reason to do it even more frequently. This is during any time where the drugs are being titrated. And you need to take in consideration the patient'e extremity as well.

If they need more critical monitioring, then they need an a-line.

In all of my years as working as an RN, I have never worked at a facility that required every five minute documentation of vital signs. You are continuously assessing your patient, and can see if any issues develop. If you need to chart them every five minutes, when are you going to be able to get meds and give them or even care for your patient?

[RoxanRN]

Ours is also documented every 15 minutes (NIBP or Aline) during titration then every 30-60 minutes while stable. If the BP is stable and we change the drip (for whatever reason), then it's 15 minute VS for at least an hour after the change(s).

[NRSKarenRN, BSN, RN]

looking for nursing standards then turn to

a. critical care textbooks

b. aacn standards

c. nursing journal articles

check what's available at your hospitals library.

aacn procedure manual for critical care, 5th ed. view table of contents

arterial pressure monitoring protocol product

monitoring arterial blood pressure: what you may not know critical ...

noninvasive blood pressure monitoring - protocols for practice: applying research at the bedside

by kathleen r. dobbin

[begalli]

In all of my years as working as an RN, I have never worked at a facility that required every five minute documentation of vital signs.

It's not necessarily a requirement but as it turns out it is a standard in our unit. Nipride especially works very quickly and when it's being actively titrated and I don't have an art-line, I just like to keep a close eye on pressures.

Also, we don't necessarily document every 5 minutes unless a pressure results in the titrating of a med. Per policy, the documentation is to be done hourly (more frequently for the first couple of hours with fresh post-ops), but if the rate at which a drug is administered has to be changed based on a bp, heart rate, etc then we will document that vital sign along with the change in rate no matter how frequent it is in addition to the hourly documentation.

All of our charting is computerized. Values on the monitor are "slaved" into the computerized flowsheet. If I needed to at the end of my shift at 0630, I could punch in the time 0341 and see what the vs were at that time and then save them into the documentation.

This is GREAT during emergencies when you don't have the time to chart every single thing as it happens.

[dfk, RN, CRNA]

i don't think there's one specific website to your query.. perhaps because there is no one set rule of thumb. nurses will take it upon themselves to keep things controlled, ordered or not, especially when titrating.

just my 0.02 cents~

[lisa4golf]

Thanks everyone for the help.

[dorimar, BSN, RN]

I have charted Q 5 min VS on very critical patients with frequent interventions. Luckily, now days with the computer charting it's not too difficult.