Intensive Care Unit & Emergency Department Drips
What is the goal mean arterial pressure (MAP) for patients receiving Vasopressors?
> or = 65 mmHg
Nurses should perform what kind of verification before initiating a high risk infusion?
Independent Verification
DAILY DOUBLE: What does an independent verification consist of?
Name a critical drip that can be used to treat malignant hypertension.
Cardene, Nitroglycerine, Labetolol, or Nipride
Which lab is closely monitored while a patient is receiving a Heparin or Argatroban drip?
aPTT
What should be added to an amiodarone IV tubing set prior to infusing?
Patient's receiving paralytic drips should always have this type of medication administered with it?
Sedative
When should critical drip rates be documented?
At shift change/handoff report, when weaning or titrating the drip, ideally every 2 hours.
DAILY DOUBLE: What should be documented with critical drip rates?
How long should you continue to infuse an amiodarone drip after giving the patient an oral dose?
30 minutes
What is the reversal agent for Heparin?
Protamine Sulfate
DAILY DOUBLE: What is the reversal agent for Argatroban?
What should be monitored every 2 hours while patient is receiving any type of IV narcotic pain management? (Other than pain level.)
Respiratory Rate, ETCO2
What type of trial should we perform on patients that are intubated and receiving sedatives and analgesics daily?
Spontaneous Awakening Trial (SAT) aka Sedation Vacation. DAILY DOUBLE: If the patient passes the SAT, who should you notify and why?
How often should nurses visually check and document on IV sites that have critical drips infusing?
AT LEAST every 2 hours or PRN patient complaints.
Your patient is receiving a Cardizem drip at 15 mg/hr, you notice that their blood pressure has dropped significantly since your last check to 82/54 (MAP 58), they are still in A.Fib with RVR with a heart rate of 128, and the patient is now only responsive to painful stimuli. How should you proceed?
Stop the drip and notify the provider and/or call RRT. May also place patient in the Trendelenburg position or give the patient a fluid challenge.
Your patient with a new diagnosis of Heparin Induced Thrombocytopenia (HIT) has been started on an Argatroban drip. What major adverse effect should you be monitoring for?
Signs and symptoms of bleeding.
Vasopressors should ideally be infused in what type of vascular access device?
Central Line or PICC Line
NOTE: Midline/Large-bore IV access is acceptable with low rates or emergently until central access is obtained.
For patients receiving Propofol, Versed, or Fentanyl drips. What must be documented every 2 hours in the patient's electronic medical records?
Rate, volume infused, volume remaining, RASS.
DAILY DOUBLE: Where is this documentation found?
All critical drip IV tubing should be labeled with a pink sticker. The sticker should include the ________ and the ______ & ______ that the drip was started written on it.
Medication Name, Date & Time
DAILY DOUBLE: The IV tubing should be labeled in what 3 locations?
Your patient has a Precedex drip infusing for agitation at 1.4 mcg/kg/hr. Their vital signs are BP 88/48, MAP 60, HR 48 (Sinus Bradycardia), RR 11, and they are lethargic with a RASS of -3 (movement or eye opening to voice but no eye contact). How should you proceed?
Decrease the rate and monitor the patient closely, possibly stop the drip depending on the patient's condition.
DAILY DOUBLE: If you are unable to wean/titrate per critical drip parameters, what must you do?
While managing an insulin drip using the Glucommander protocol, if a patient's initial blood glucose reads "HIGH" on the glucometer, what should you enter for the blood glucose level on the Glucommander screen?
Press the "Meter MAX" button.
Which drip requires non-polyvinyl chloride (PVC) IV tubing (aka blue tubing)?
Your patient is receiving a Levophed drip, a Vasopressin drip, a Neo-Synephrine drip, and an Epinephrine drip. All drips are infusing at maximum rates into the patient's central line and you are having to continuously hang new bags. What can be done to alleviate having to change the bags so frequently?
Obtain an order from the provider for your vasopressors to be changed to QUAD-strength doses. *QUAD-strength has 4 times the dose compared to the regular strength, it will decrease the frequency of having to change the bags.
Before combining drips into a single line, often called Y-siting, what should you check?
To see if the drugs are compatible to infuse together.
DAILY DOUBLE: Where can you check for IV compatibility?
Which vasopressor might be a better alternative for a patient who is tachycardic while receiving a Levophed drip?
Neo-Synephrine
Patients receiving insulin drips should have what added to their IV fluids once their blood glucose reaches 250 mg/dl or less consecutively?
D5W
Name one critical drip that requires protection from light.
Nitroglycerin, Levophed, Nipride, Neo-Synephrine, Dobutamine, or Dopamine