Why would someone be on a Cardizem drip for 4+ days?

Published

Specializes in Acute Care.

got a pt transferred today from ccu - had been admitted to our cardiac unit with chf/arf, went into a fib, started on cardizem - stroked out at some point (i was told the pt showed sx of cva at 11pm one night and no one did anything until 6am the next morning when the pt fell oob, r side flaccid:eek:), and was transferred to ccu. 4 days later - pt still on cardizem drip. not sure why pt was still on it - he was still in a fib, hr jumping anywhere from 85-105 - measured a few discernibleprs and they'd range anywhere from wnl to 0.32. called cardiologist on call (pts primary was a cardiologist) - he said "why is he still on cardizem drip" - also explained to him when pt was transferred, we also had orders to continue the prn lidocaine boluses/drip for frequent pvcs or vtach... explained to him, we are not even cardiac tele and the only cardiac drip we do is cardizem... no amiodarone or lidocaine. then he said "why would they transfer him to medical tele anyway?" - there was a torb specifically written for the pt to be transferred to our unit (i'm guessing b/c we are the stroke unit. got an order for po cardizem, d/c the drip and d/c lidocaine.

of course, to make matters worse, i got the order for po cardizem and 2 hr later, still hadnt recieved it from pharmacy despite 1 call and 2 messages sent to them ... when they finally did send it, i got a cardizem drip :banghead:.

anyway, i guess my question is, why would they keep a person on a cardizem drip for so long? i thought cardizem was like a 24 hr max medication for you attempt to switch to po? i mentioned this to the ccu nurse and she was like ":confused:".

Up Vote Up Vote ×
Specializes in ICU/Critical Care.

I've never had anyone on cardizem that long. Usually when the rate is below 100 and its been stable, the doc orders po cardizem ATC. Seems strange to keep him on it that long.

Up Vote Up Vote ×
Specializes in Cardiac, ER.

Perhaps with the CVA he wasn't able to take PO?

Up Vote Up Vote ×
Specializes in ICU/Critical Care.
Perhaps with the CVA he wasn't able to take PO?

This could be very very true.

Up Vote Up Vote ×
Perhaps with the CVA he wasn't able to take PO?

That's the most likely scenario.

Up Vote Up Vote ×
Specializes in Neuro ICU and Med Surg.

Well if that is the case why not a NGT or dobhoff until peg placement? No I haven't seen anyone on a Cardized gtt that long. Within 24 hours we are placing them on PO/NGT cardizem.

Up Vote Up Vote ×

Recently, I had a pt on my unit who was on a Cardizem gtt for over a week(I think 2 or 2 1/2) because the pt couldn't take pills(stroke) and couldn't have an NG or Peg d/t massive abdominal issues. The cardiologist was trying to get the pt managed on IVP lopressor so that the cardizem could be d/c'd. Our usual course would be to start po cardizem shortly after IV gtt was started. However, in this facility, I can say that most on the gtt are on it more than 24 hours.(Docs are not very aggressive, can you tell?)

Up Vote Up Vote ×
got a pt transferred today from ccu - had been admitted to our cardiac unit with chf/arf, went into a fib, started on cardizem - stroked out at some point (i was told the pt showed sx of cva at 11pm one night and no one did anything until 6am the next morning when the pt fell oob, r side flaccid:eek:), and was transferred to ccu. 4 days later - pt still on cardizem drip. not sure why pt was still on it - he was still in a fib, hr jumping anywhere from 85-105 - measured a few discernibleprs and they'd range anywhere from wnl to 0.32. called cardiologist on call (pts primary was a cardiologist) - he said "why is he still on cardizem drip" - also explained to him when pt was transferred, we also had orders to continue the prn lidocaine boluses/drip for frequent pvcs or vtach... explained to him, we are not even cardiac tele and the only cardiac drip we do is cardizem... no amiodarone or lidocaine. then he said "why would they transfer him to medical tele anyway?" - there was a torb specifically written for the pt to be transferred to our unit (i'm guessing b/c we are the stroke unit. got an order for po cardizem, d/c the drip and d/c lidocaine.

of course, to make matters worse, i got the order for po cardizem and 2 hr later, still hadnt recieved it from pharmacy despite 1 call and 2 messages sent to them ... when they finally did send it, i got a cardizem drip :banghead:.

anyway, i guess my question is, why would they keep a person on a cardizem drip for so long? i thought cardizem was like a 24 hr max medication for you attempt to switch to po? i mentioned this to the ccu nurse and she was like ":confused:".

i read this and thought to myself "another day in paradise". i have been through situations like this so many times. good luck and god bless.
Up Vote Up Vote ×
Specializes in ICU, Psych.

Actually I have seen someone on several drips including Cardizem for almost 2 weeks, the guy also had dead bowel syndrome. So in case of non-absorption or an absorption rate that is uncertain or unstable would be such a case.

Also I have seen people who had major bowel surgery get put on IV meds only order so their bowel can "concentrate" on their tube feedings without having to absorb chemicals. Depends on the doc's philosophy.

Up Vote Up Vote ×
Specializes in ICU.

although the goal of treatment is to stabilize on a gtt then convert to po cardizem q6hr, then long acting cardizem q12, being on a gtt for that amount of time is not unheard of especially when you want a tighter control due to complications or instability of other systems, in this case, neuro. :heartbeat

Up Vote Up Vote ×
+ Join the Discussion