Levophed drip12/27/2023 Several investigators have evaluated the stability of norepinephrine in solutions intended for IV administration. 4 The monograph also indicates that vials should be stored in the shipping carton, with protection from light, but no such caution is indicated for diluted solutions, and no expiry date is offered for diluted solutions. The product monograph for one brand of this drug, Levophed, indicates that it should be administered in solutions containing 5% dextrose to limit the significant loss of potency through oxidation. Norepinephrine is primarily used to restore and maintain blood pressure in a variety of situations. 1 For many drugs, extending the beyond-use date may facilitate admixture in the pharmacy, reduce wastage, 2, 3 and result in significant cost savings. However, when reconstitution and dilution are carried out in a sterile environment, based on the guidance of USP (United States Pharmacopoeia) Chapter recommendations, it is entirely reasonable to assign beyond-use dates of up to 14 days for low-risk compounded sterile products. If it infiltrates it can cause necrosis.The expiry date of medications intended for IV administration following reconstitution or dilution is often limited to about 24 h, even when data on extended stability exist, because of the potential for breaks in sterility and contamination of the product. 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 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. 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. Do not allow vesicant drugs to infuse through a peripheral IV very long. ![]() If you are starting a vasoactive/vesicant drip – YOU NEED A CENTRAL LINE. 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.ġ1. 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. Chart all of your titrations in real time. You’ll always know what is what very quickly!ĩ. Label your lines clearly near the first Y-port. Utilize your IV lines and ports appropriately.Ĩ. Surprisingly, many drips are compatible with a lot of things. Check IV compatibility when you’re hanging antibiotics or other IVPB meds. Our non-Facebook community is just what you need.ħ. 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! If they are on a drip to INCREASE their blood pressure, do not give their scheduled antihypertensives. Don’t forget your critical thinking skills! Remember when giving other meds what the drip is for. 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).Ħ. 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. ![]() 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. ![]() Know when you need to call with concerns/questions. Your bolus bag only takes 10 minutes and that goes by very, very quickly. Or if you are hanging an Amiodarone drip, make sure you have your bolus bag AND your second bag ready. You do not want to push the med and then wait for the bag to come up from pharmacy. 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. Have everything you need before you start your drip. 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.Ĥ. If you don’t know exactly how to titrate/manage the drip, print the policy. For example, if you’re about to start a heparin drip you typically need a baseline PTT or Anti-Xa.ģ. Collect necessary baseline labs, like, now. Roberson in bed 28 really wants his suppository but he will have to wait.Ģ. When you get an order to start a drip, that becomes your priority. Here are my 11 points of enlightenment when working with drips!ġ. I’m going to do a few posts on various drips that are geared towards newer nurses.
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