Which weight with titration?? daily wt or dry wt?

[jbp0529]

Hello all:

I'm currently trying to get some feedback on an issue that comes up every so often in my unit... titrating weight-dosed IV meds like dopamine, propofol, dobutamine, etc based on the daily wts or the idea of "just pick a weight and stay with it and titrate to pt's respose to the med."

The policy (although I have yet to actually find it on paper in our unit's P & P book) is to change the wt every day. Most often the change in wt is fairly insignificant, resulting in the actual "ml/hr" only being increased or decreased in terms of decimal points. However once in a blue moon there is a larger change in the infusion rate.

Personally speaking, from the little research I have found, everyone has their own policy and there doesn't seem to be a true gold standard out there. Myself, I am of the opinion that one should just pick a weight and titrate to the response, and that weight changes of up to 10 kg don't affect the ml/hr in a large way.

One also has to consider the accuracy of the bed scales at times (some of them on my unit can be pretty goofy), and the technique of the person who got the last weight (did they do it properly, or where there 10,000 pillows and blankets and an overflowing foley bag on the bed frame).

Any thoughts??

~ Jim

[cardiacRN2006, ADN, RN]

We titrate to dry weight. I think I'll look it up in the P&P just to be sure.

[jmgrn65, RN]

I would think dry weight, what their wt. with fluids that have 3rd spaced isn't thier true body wt. Thier liver and kidney are still the same size.

[TennRN2004]

dry weight

[begalli]

dry weight

[ccrnjen]

Had this very issue come up at work today. I was always taught to base titrations on the dry weight - or rather - the pt's admit weight. Weight changes, particularly weight gains that we see so often, is usually a result of fluid and third spacing. This fluid does nothing to metabolize, utilize or store the medications.

[UWSRN]

Definately DRY weight. We do all our medications, gtts, and electrolyte replacement by dry weight.

[kld0429]

Interestingly, we just implemented daily wt based critical care drips last week. MD request from Med Exec.

[cardiac.cure03]

They keep telling me in school that the only dumb question is the question that's not asked, so...

What's a "dry weight" ?

Thanks in advance :)

[painter6]

basically dry weight is the patients normal weight. When the patients are not fluid overloaded, or third spaced. When they are 3rd spacing they weigh more, but that is not acutally there true weight, because that fluid is just sitting in the extra-cellular space.

In our unit we usually use the patients admission weight, don't know if that is the right way, but I think it seems to work the best.