Download Neuromuscular Blocking Agent (NMBA) Orders

PLACE LABEL HERE
NEUROMUSCULAR BLOCKING AGENT (NMBA)
ORDERS
The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked.
Initial all handwritten order modifications and the bottom of each page when indicated (multipage).
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Mechanical Ventilation Initiation Orders (form # 18389) are required
Mechanical Ventilation Sedation Critical Care Orders (form # 15395) are required
Maintain RASS: -5
Central intravenous access preferred or a minimum of 2 peripheral intravenous sites
Monitor twitch response and percent of blockade with peripheral nerve stimulator q 2 hrs. If not within
goal range, titrate infusion q 15 min until goal range achieved.
Adjust the rate of NMBA continuous infusion based on response from peripheral nerve stimulator and
neuromuscular assessment to achieve 90% block = 1 twitch response
When “wake up” assessment is ordered by physician
 Nurse and Respiratory Therapist to coordinate, as needed
 Stop NMBA for 1 hr q 12 hrs if approved by the physician
 Restart at same or less rate when Train-of-Four equals 4 twitches and/or patient becomes
hemodynamically/neurodynamically unstable
 Notify physician if unable to obtain a Train-of-Four or block recovery
Physical therapy to provide L’Nard boot. Rotate boot q 2 hrs between feet.
Tape eye lids closed
Patient weight ______ kg
MEDICATIONS
11.
NMBA Loading Dose:
 Norcuron (vecuronium) 0.1 mg/kg IV Push x 1 dose
 Nimbex (cisatracurium) 0.2 mg/kg IV Push x 1 dose
12.
NMBA Continuous Infusion Dose:
 Norcuron (vecuronium) 50 mg in 250 ml normal saline. Begin at 1 mcg/kg/min then adjust to
maintain 90% suppression of twitch response. (Infusion range 0.8-1.2 mcg/kg/min)
Renal/Liver failure patients:
 Nimbex (cisatracurium) 200 mg in 200 ml normal saline. Begin at 3 mcg/kg/min then adjust
to maintain 90% suppression of twitch response. (Infusion range: 0.5-10 mcg/kg/min)
13.
Lacrilube (mineral oil/petrolatum) apply ointment to both eyes q 6 hrs. DC Isopto Tears (hypromellose)
if previously ordered.
14.
Sedation Continuous Infusion Dose:
Patient must have continuous Anxiolytic AND Analgesic infusions prior to starting on
paralytics.
PRN Medications
15. Emergency Reversal Agent:
Neostigmine methylsulfate 1 mg slow IV Push. May repeat q 5 minutes prn up to max total dose of 5 mg.
Atropine 0.02 mg/kg IV Push with each dose of Neostigmine.
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Date
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Time
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Physician Signature
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PID Number
Copy to pharmacy
*1-15396*
FORM 1-15396 REV. 12/2014
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