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Q I am looking for educational information on the administration of Diprivan, Morphine, Ativan, Levophed, Dopamine and Epinephrine, specifically the indications for titration of these medications; i.e., vital signs, perfusion and level of consciousness, to effect a favorable outcome.

A Several things need to be taken into consideration when administering vasoactive drips:

* the stability and condition of the patient

* hospital and unit policy

* the competency level of the nurse

* titration

* the half-life of the medication

Titrating vasoactive drips is definitely an art and a science. Working with one of your pharmacists, look at the medications and concentrations most frequently used on your unit and develop a table based on medication half-life and your patient population. As a nurse you are practicing within the parameters set by the physician for the titration of these medications. You maintain the monitoring parameters that were set as a goal for the use of the medication.

Monitoring of vital sign frequency should be determined by the needs of the patient; that is, vital signs should be documented when there are any changes rather than at a set frequency. The frequency of vital sign monitoring should be determined by the specific medication being infused, the half-life of the medication and the titration. If you read the manufacturer's instructions for each medication it will give you information on monitoring. A medication with a very short half-life, such as nitroglycerin/nitroprusside, should be monitored more frequently than every 15 minutes when titrating because the effect should occur very quickly.

AACN offers many resources that will guide you in medication administration and titration. Every year there are sessions at NTI that address the administration of these drugs.

"AACN Essentials of Critical Care Nursing" includes a table with information on vasoactive agents and their pharmacological effects:

"AACN Essentials of Critical Care Nursing"

M. Chulay, S. Burns

Product #128750

Member price: $59.50

Nonmember price: $62.65

The AACN Medication Calculation Pocket Card also contains valuable information on administering these medications:

AACN Medication Calculation Pocket Reference

Product #400851

Member price: $2

Nonmember price: $4

In "AACN Protocols for Practice: Care of Mechanically Ventilated Patients" (2nd ed.) read the chapter titled "Sedation and Neuromuscular Blockade in Mechanically Ventilated Patients." There are many resources in Critical Care Nurse and American Journal of Critical Care. Listed below are two articles that are available online from Critical Care Nurse. You can download them at http://ccn.aacnjournals.org/.

October 2000

Sedation and Pain Management in Critically Ill Adults

Richard Arbour, RN, BSN, CCRN, CNRN

August 1998

Use of Propofol for Sedation in the ICU

Holly Covington

Some states restrict the use of Diprivan to CRNAs/anesthesiologists, because it is listed as an anesthetic induction agent. Check with your state board of nursing and refer to the Nursing Practice Act to determine the practice in your state.

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Publication:AACN News
Geographic Code:1USA
Date:Jun 1, 2008
Words:472
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