How to Titrate a Cardizem Drip

imageMany nurses are apprehensive about having to titrate a Cardizem drip. Patients who require Cardizem are usually facing life threatening conditions like A-fib and this can be very stressful to a nurse who doesn’t typically deal with this sort of condition. Depending on your floor there may actually be policies that states that you should transfer patients to critical care or intensive care units if they require titration on a Cardizem gtt. You should make sure that you are familiar with your facilities policy on the subject of Cardizem drips before you take responsibility for this nursing skill.

What is Cardizem Used for and How Does it Work?

Cardizem is a medication administered for cardiac conditions. According to

A calcium channel blocker used to slow the ventricular rate of rapid atrial fibrillation and atrial flutter. Calcium contributes to the contraction of the heart and constriction of the arteries. Blocking the movement of calcium relaxes vascular smooth muscle (decreasing peripheral resistance) lowering the blood pressure and slowing conduction through the AV node which slows the heart rate which will reduce the work load of the heart.
When the patient sustains a rapid heart rate it could lead to an increased risk of myocardial damage (cardiomyopathy) and deterioration into ventricular fibrillation. The varying stroke volume (amount of blood pumped out of the ventricle with each contraction) decreases and causes the cardiac output to decrease. Patients will need intervention when the heart rate is over 100 and they are symptomatic.

Goal of therapy:
Rate control – can be accomplished in the field with medication
Maintenance of sinus rhythm – done in-hospital
Prevention of thromboembolism – initiated in hospital with medication

Rapid atrial fibrillation is a life-threatening condition and should be handled as an emergency issue once identified.

Monitoring the Patient

imagePatient’s with Cardizem drips are facing cardiac issues which require close surveillance and monitoring by a nurse. This often means 2 on 1 or perhaps even 1 on 1. At the very least the patient needs to be on a cardiac telemetry monitor so that a telemetry nurse can monitor their rhythm and help you stay aware of any changes they see. This is not a substitute for eyeing the patient, but is an extra safeguard and is usually required by the hospital. If it’s not required, it’s still a good idea to ask the doctor for an order for cardiac monitoring. No nurse I know can tell a patient’s heart rhythm just by looking at them. If you can, you need to contact me and tell me when you developed super powers.

Titrate According to the Heart Rate

While monitoring a patient on a Cardizem drip can be intimidating to a newbie, it’s pretty straight forward.

The initial dosing of Cardizem for A-fib/flutter might be something like the following:

Dosing (A-fib/flutter) initially 0.25 mg/kg over 2 min. If inadequate give 0.35 mg/kg over 2 min-15 min after 1st dose. Subsequent doses should be individualized. Continuous infusion: started immediately following an effective bolus dose. Initial rate= 10 mg/hr (some may respond to 5 mg/hr). If needed, may increase up to 15 mg/hr. Contraindicated: AMI, hypotension (sys<90), 2nd & 3rd degree AV block.

If the patient’s heart rate rises about the rate specified by the physician you increase the rate. If the rate dips below what you desire, you decrease the rate. Titrating Cardizem isn’t impossible, or even that hard really, you just have to know the parameters to follow.  You should also monitor the patient’s blood pressure. If their systolic pressure drops below 90 then then Cardizem is contraindicated.

You also have to make sure that you are paying attention to the patient and not just vital signs. If the patient tells you they feel like something bad is going to happen or that they are about to die LISTEN TO THEM!

Advocate for the Patient

Your biggest job as a nurse is to keep the patient’s best interest at heart. Even if you know how to titrate a Cardizem drip, it doesn’t mean that you should if it is putting the patient in more risk. You need to make sure you have ample resources, training, and confidence to get the job done. You also need to make sure that the patient can handle the medication and you need to explain the medication to their patient and their families,

If the patient needs to transferred to another unit to more closely monitor their infusions it does not mean that you are not a good nurse. On the contrary, it means that you are a good enough nurse to make sure your patients get the best care possible.

Cardiac nurses are some of the bravest and skilled nurses I know. I’ve seen CCU nurses bring patient’s back from near death through an organized ballet of V-Fib. I have personally saved a life by paying close attention to my patient’s condition and pushing a few ml of Cardizem. Whether you work in the ER, OR, ICU, CCU, Med Surg, or a long term care facility, you have the ability to make a difference and save a life by paying attention to their needs and delivering the best nursing care possible. This means knowing how to titrate a Cardizem drip.

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