POLICY
Medication name
2. Medication route
3. Initial/starting rate/dose
4. Incremental units the rate/dose can be increased or decreased
5. Frequency for incremental doses (how often rate/dose) can be increased or
decreased
6. Maximum rate/dose of infusion
7. Objective & measurable clinical endpoint &/or goa
What are the titration order requirements?
Dihydropyridine calcium channel blocker that reduces blood pressure by reducing systemic vascular resistance without reducing cardiac filling pressure
What is Clevidipine (Cleviprex)?
This is the component of stroke volume that is increased when a positive inotrope is administered.
What is contractility?
This is a validated & reliable method to assess patients’ level of sedation in the intensive care unit. It is mostly used in the setting of mechanically ventilated patients in the ICU to avoid over- & under-sedation.
What is the Richmond Agitation Sedation Scale (RASS)?
The action of this receptor when stimulated is vasoconstriction.
What is alpha?
Mean arterial pressure (MAP) 60-65mmHg
Systolic blood pressure (SBP) greater than 120mmHg
Heart rate (HR) less than 100 BPM
Richmond Agitation Sedation Score (RASS) 0 to -1
Cardiac index greater than 2.2 L/min/m2
What are examples of acceptable objective and measurable clinical endpoints or titration goals?
--VFib/VTach & cardiac arrest – dilution unnecessary
--Loading dose for tachyarrhythmias – 150 mg in 100 mL D5W over 10 minutes
--Maintenance dose – 900 mg in 500 mL D5W
--Maintenance infusion must be in glass bottle or non-PVC bag
--Administer through an IV line with an in-line filter
What is preparation and administration of Amiodarone?
Primarily stimulates beta-1 receptors causing increased cardiac contractility, heart rate & cardiac output.
What is Dobutamine?
This is a valid & reliable delirium assessment tool recommended by the Society of Critical Care Medicine (SCCM), critically ill patients should be assessed at least once per shift.
What is the Confusion Assessment Method for ICU (CAM-ICU)?
Utilized as the first line vasopressor for septic shock & treatment of acute hypotension from a variety of causes. Indicated when there is a marginally low CO with a low BP caused by a low SVR
What is norepinephrine (Levophed)?
An abbreviated method of charting that may be utilized in the
care of patients during which normal medication documentation would put undue
strain on the ability of appropriately trained healthcare professionals to provide high
level care for critically ill unstable patients.
What is block charting?
Class II anti-arrhythmic with a very short half-life that is a cardioselective beta-blocker. It primarily blocks beta-1 receptors & at high doses inhibits beta-2 receptors. Used for treatment of supraventricular tachycardia, atrial fibrillation/atrial flutter, myocardial infarction, thyrotoxicosis, aortic dissection, & hypertensive crisis.
What is Esmolol?
Positive inotropic, lusitropic agent, & vasodilator that acts by inhibiting phosphodiesterase III & increasing intracellular cyclic AMP.
What is Milrinone?
Analagosedation preferred to be used first in intubated patients, approximately 50-100 times more potent than morphine on a weight basis
What is fentanyl?
This potent vasoconstrictor is useful in treating hypotension when CO is normal, but SVR is low. It has no direct effects on heart rate & contractility.
What is phenylephrine (Neosynephrine)?
1. Date & time initiated
2. Name(s) of medications administered
3. Rate of eligible medication(s) at the initiation
4. Maximum rate achieved of eligible medication(s)
5. Assessment method &/or objective & measurable clinical endpoint titration goal used during the titration of eligible medication(s)
6. Rate of eligible medication(s) at the completion
7. Date & time stopped
What are block charting documentation requirements?
Alkalinizing agent for the treatment of preexisting metabolic acidosis, hyperkalemia, drug overdose (tricyclic antidepressant, salicylates, phenobarbital) or after prolonged cardiac arrest.
What is sodium bicarb?
Stimulation of these receptors results in increased contractility, heart rate, & conduction
What are beta-1?
Dissociative sedative-hypnotic . Used for procedural sedation, intubation, continuous sedation of intubated patients, & analgesia.
What is ketamine?
This drug, used for treatment of extravasation of IV catecholamines, is given using a syringe with a fine hypodermic needle (27 to 30 gauge) making multiple injections liberally
throughout the area of extravasation.
What is phentolamine (Regitine)?
Shown here italicized, bolded, & underlined:
Norepinephrine continuous IV, titrate by 0.1 to 5 mcg/min not more frequently than every 1 minute to a maximum of 30mcg/min to maintain a MAP > 65 mmHg.
What is an example of a range order?
This drug can cause an infusion syndrome charaterized by: metabolic acidosis, hyperkalemia, lipemia, rhabdomyolysis, hepatomegaly, cardiac/ renal failure
What is propofol?
These 2 common high risk drugs can also be used as positive inotropes when administered at LOW doses
What are Dopamine & Epinephrine?
Bolus is the preferred method of administration of this anxiolytic sedative to avoid accumulation & prolonged ventilation times/ ICU length of stay.
What is midazolam (Versed)?
Low doses stimulate alpha 1 receptors to cause peripheral vasoconstriction and ↑ BP
Intermediate doses (5-10 mcg/kg/min) stimulate beta 1 receptors to ↑ myocardial contraction & cardiac output
High doses (>10 mcg/kg/min) stimulate alpha 1 receptors to cause peripheral vasoconstriction and ↑ BP.
What is dopamine?