I’m going to do a few posts on various drips that are geared towards newer nurses. Here are my 11 points of enlightenment when working with drips!
1. When you get an order to start a drip, that becomes your priority. Yes, I know Mr. Roberson in bed 28 really wants his suppository but he will have to wait.
2. Collect necessary baseline labs, like, now. For example, if you’re about to start a heparin drip you typically need a baseline PTT or Anti-Xa.
3. If you don’t know exactly how to titrate/manage the drip, print the policy. That will tell you everything. Including weaning parameters. If they’re at 5 mg/hr of Cardene and they’re well below their blood pressure limit – wean it off! Always, always be looking to wean as soon as it is clinically appropriate.
4. Have everything you need before you start your drip. If they want a 10 mg bolus of Cardizem before you start your drip, make sure you have both the bolus and the drip bag in your hands. You do not want to push the med and then wait for the bag to come up from pharmacy. Or if you are hanging an Amiodarone drip, make sure you have your bolus bag AND your second bag ready. Your bolus bag only takes 10 minutes and that goes by very, very quickly. Have everything FIRST.
5. Know when you need to call with concerns/questions. For example, if they’ve been on a Cardizem drip for an hour and a half, are maxed out, and they are in afib with a heart rate of 140 – you need to call. It’s not working. Conversely, if they’ve been on a Cardizem drip for 2 days and there’s no orders for PO or talk of converting to PO – call and ask about the plan if it’s not written in a note. They may round a 1300 and ask why they weren’t notified that there aren’t any orders for PO Cardizem and why they are STILL on the drip and no one told them (cough-becauseyourcolleaguedidntorderthem-cough).
6. Don’t forget your critical thinking skills! Remember when giving other meds what the drip is for. If they are on a drip to INCREASE their blood pressure, do not give their scheduled antihypertensives. You’ll have to talk to the doctor about the plan because they’re still ordered (maybe a MAR hold until the drip is no longer needed or maybe they just need to be discontinued all together.) Just make sure you think before you medicate – don’t get on autopilot!
7. Check IV compatibility when you’re hanging antibiotics or other IVPB meds. Surprisingly, many drips are compatible with a lot of things. Utilize your IV lines and ports appropriately.
8. Label your lines clearly near the first Y-port. You’ll always know what is what very quickly!
9. Chart all of your titrations in real time. Otherwise, things get very confusing.
10. Make sure your pump is programmed correctly (with the correct concentration!), make sure your order is written correctly, and if it is a weight based drug make sure the weight programmed in the pump is current/correct and coincides with your last charted weight. If they’ve been on Propofol for a 4 days, been NPO, and had multiple doses of Lasix and diarrhea, I bet their weight has changed since the drip was started.
11. If you are starting a vasoactive/vesicant drip – YOU NEED A CENTRAL LINE. Do not allow vesicant drugs to infuse through a peripheral IV very long. It’s typically okay to start them in a PIV just to get the drug in them, but this needs to be transitioned to a central line ASAP. If you have an order for a PRN Levophed drip that you start in a PIV and don’t alert the doctor (“hey I just wanted you to know that Mr. Smith now needs Levo at 5 to maintain his BP limits and he only has two peripherals”), that is a big problem and it would be entirely your fault. If it infiltrates it can cause necrosis.
Does anyone have any helpful hints for newbies? Or any learning experiences?