ATI Critical Care
Your responsibilities include:
• inserting peripheral IV catheters
• starting continuous IV infusions
• administering medications
• monitoring IV sites
Providers prescription includes:
• type of fluid
• the volume the client needs
• rate to infuse the fluid
Administering IV Fluids
• large-volume continuous IV infusions
• Large volume IV bolus
• Intermittent IV infusion
• IV Bolus medication - short lasting
IV Flow Rates
Large-volume IV bolus
• Given rapidly to replace fluid loss resulting from:
• dehydration
• shock
• hemorrhage
• burns
• trauma
• Dextrose 5% in 0.45% sodium chloride
• (D5W 0.45% NaCl)
• 250 mL over 15 min
• Monitor for: wheezing dyspnea, or other indications of fluid overload
• Use a large gauge angiocatheter or central line to allow rapid
infusion of the fluid
Calculating dosages for continuous IV infusions
• Infusion pump for continuous IV medication infusions
• use electronic pump for continuous IV medications
• Units/hr, mg/hr, mg/min, mcg/kg/min
• Titrate dosage to maintain prescribed parameters
• Check dosage with another nurse
,IV Heparin
• Anticoagulant; prevents blood clots
• Give initial IV bolus, then continuous IV infusion:
• Follows acute myocardial infarction
• Prevents additional clot formation for venous thrombosis
• Initial IV bolus: units/kg
• Continuous infusion: units/kg/hr
IV Magnesium Sulfate
• Electrolyte that activates many intra-cellular enzymes; helps regulate
skeletal muscle contractility & blood coagulation
• Acute myocardial infarction, cardiac arrest, seizures secondary yo
eclampsia, preterm labor, magnesium deficiency
• Monitor:
• cardiac & neuromuscular status
• serum Mg levels
• hypotension
• depresses cardiac function
• depressed or absent deep tendon reflexes
• respiratory depression
• IV bolus: mg/kg, or
• Continuous IV infusion: mg/hr
IV Labetadol (Trandate)
• Antihypertensive
• 3rd generation adrenergic receptor blocking agent with alpha &
nonselective beta activity
• alpha blockade results in vasodilation to decrease peripheral
resistance & lowers blood pressure
• Beta blockade decreases heart rate, myocardial contractility, &
rate of conduction through the AV node
• the vasodilation makes it effective in severe hypertension
• Severe hypertension
• Monitor:
• vital signs
• cardiac status
• hypotension
• bradycardia
• nausea
, • dizziness
• sweating
• IV bolus: mg
• Continuous IV infusion: mg/min
IV Dopamine
• Cardiac stimulant, vasopressor
• aka Intrepid is an alpha & beta adrenergic agonist
• activates beta-1 receptors in the heart & increases cardiac output
leading to increased tissue perfusion
• activates dopamine receptors in the kidneys, which dilate renal
vessels leading to increased GFR & urinary output
• Used treatment of:
• Heart failure
• cariogenic shock
• septic shock
• Continuous IV infusion: mcg/kg/hr
• Monitor:
• vital signs
• cardiac status for:
• tachycardia
• dysrhythmias
• angina pain
• MI
• High doses can cause alpha-1 activation leading to local
vasoconstriction so monitor for extravasation
Titrating Continuous IV Medication Infusions
Titrating a continuous IV medication infusion is adjusting the medication
amount in small amounts to maintain assessment findings within a
prescribed range
• Continuous client monitoring
• Dosages based on parameters
• Parameter examples:
• blood pressure
• heart rate
• cardiac output
• sedation level
• Accurate dosage calculation
• Medications:
, • dopamine
• heparin
• nitroprusside
• norepinephrine
• dobutamine
• nitroglycerin
IV Nitroprusside (aka Nipride)
• Non-nitrate vasodilator, antihypertensive
• Causes direct vasodilation of arteries & veins, rapidly reducing BP
• Used for hypertensive crisis
• effects start immediately; critical to monitor BP within prescribed
range
• Continuous IV infusion: mcg/kg/min
• Monitor:
• vital signs
• cardiac status for:
• profound hypotension
• bradycardia
• tachycardia
• ECG changes
• tinnitus
• blurred vision
• fatigue
• absent reflexes
• change in mental status (can indicate thiocyanate toxicity)
IV Nitroglycerin (Tridil)
• Organic nitrate
• Vasodilator of arteries and veins
• Results in:
• rapid reduction of blood pressure
• decrease in venous return
• decreases cardiac oxygen demand
• Useful for:
• Acute coronary syndrome
• angina
• myocardial infarction
• acute hypertensive crisis
• IV bolus: mg
Your responsibilities include:
• inserting peripheral IV catheters
• starting continuous IV infusions
• administering medications
• monitoring IV sites
Providers prescription includes:
• type of fluid
• the volume the client needs
• rate to infuse the fluid
Administering IV Fluids
• large-volume continuous IV infusions
• Large volume IV bolus
• Intermittent IV infusion
• IV Bolus medication - short lasting
IV Flow Rates
Large-volume IV bolus
• Given rapidly to replace fluid loss resulting from:
• dehydration
• shock
• hemorrhage
• burns
• trauma
• Dextrose 5% in 0.45% sodium chloride
• (D5W 0.45% NaCl)
• 250 mL over 15 min
• Monitor for: wheezing dyspnea, or other indications of fluid overload
• Use a large gauge angiocatheter or central line to allow rapid
infusion of the fluid
Calculating dosages for continuous IV infusions
• Infusion pump for continuous IV medication infusions
• use electronic pump for continuous IV medications
• Units/hr, mg/hr, mg/min, mcg/kg/min
• Titrate dosage to maintain prescribed parameters
• Check dosage with another nurse
,IV Heparin
• Anticoagulant; prevents blood clots
• Give initial IV bolus, then continuous IV infusion:
• Follows acute myocardial infarction
• Prevents additional clot formation for venous thrombosis
• Initial IV bolus: units/kg
• Continuous infusion: units/kg/hr
IV Magnesium Sulfate
• Electrolyte that activates many intra-cellular enzymes; helps regulate
skeletal muscle contractility & blood coagulation
• Acute myocardial infarction, cardiac arrest, seizures secondary yo
eclampsia, preterm labor, magnesium deficiency
• Monitor:
• cardiac & neuromuscular status
• serum Mg levels
• hypotension
• depresses cardiac function
• depressed or absent deep tendon reflexes
• respiratory depression
• IV bolus: mg/kg, or
• Continuous IV infusion: mg/hr
IV Labetadol (Trandate)
• Antihypertensive
• 3rd generation adrenergic receptor blocking agent with alpha &
nonselective beta activity
• alpha blockade results in vasodilation to decrease peripheral
resistance & lowers blood pressure
• Beta blockade decreases heart rate, myocardial contractility, &
rate of conduction through the AV node
• the vasodilation makes it effective in severe hypertension
• Severe hypertension
• Monitor:
• vital signs
• cardiac status
• hypotension
• bradycardia
• nausea
, • dizziness
• sweating
• IV bolus: mg
• Continuous IV infusion: mg/min
IV Dopamine
• Cardiac stimulant, vasopressor
• aka Intrepid is an alpha & beta adrenergic agonist
• activates beta-1 receptors in the heart & increases cardiac output
leading to increased tissue perfusion
• activates dopamine receptors in the kidneys, which dilate renal
vessels leading to increased GFR & urinary output
• Used treatment of:
• Heart failure
• cariogenic shock
• septic shock
• Continuous IV infusion: mcg/kg/hr
• Monitor:
• vital signs
• cardiac status for:
• tachycardia
• dysrhythmias
• angina pain
• MI
• High doses can cause alpha-1 activation leading to local
vasoconstriction so monitor for extravasation
Titrating Continuous IV Medication Infusions
Titrating a continuous IV medication infusion is adjusting the medication
amount in small amounts to maintain assessment findings within a
prescribed range
• Continuous client monitoring
• Dosages based on parameters
• Parameter examples:
• blood pressure
• heart rate
• cardiac output
• sedation level
• Accurate dosage calculation
• Medications:
, • dopamine
• heparin
• nitroprusside
• norepinephrine
• dobutamine
• nitroglycerin
IV Nitroprusside (aka Nipride)
• Non-nitrate vasodilator, antihypertensive
• Causes direct vasodilation of arteries & veins, rapidly reducing BP
• Used for hypertensive crisis
• effects start immediately; critical to monitor BP within prescribed
range
• Continuous IV infusion: mcg/kg/min
• Monitor:
• vital signs
• cardiac status for:
• profound hypotension
• bradycardia
• tachycardia
• ECG changes
• tinnitus
• blurred vision
• fatigue
• absent reflexes
• change in mental status (can indicate thiocyanate toxicity)
IV Nitroglycerin (Tridil)
• Organic nitrate
• Vasodilator of arteries and veins
• Results in:
• rapid reduction of blood pressure
• decrease in venous return
• decreases cardiac oxygen demand
• Useful for:
• Acute coronary syndrome
• angina
• myocardial infarction
• acute hypertensive crisis
• IV bolus: mg
