Norcuron
vecuronium
(ve-cure-oh-nee-yum) vecuronium,Norcuron
(trade name)Classification
Therapeutic: neuromuscular blocking agents nondepolarizingIndications
Action
Therapeutic effects
Pharmacokinetics
Time/action profile
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| IV | 1–3 min | 3–5 min | 30–40 min |
Contraindications/Precautions
Adverse Reactions/Side Effects
Respiratory
- bronchospasm
Dermatologic
- rash
Miscellaneous
- allergic reactions including anaphylaxis (life-threatening)
Interactions
Drug-Drug interaction
Intensity and duration of paralysis may be prolonged by pretreatment with succinylcholine, general anesthesia (inhalation), aminoglycosides, vancomycin, tetracyclines, polymyxin B, colistin, clindamycin, lidocaine, and other local anesthetics, lithium, quinidine, procainamide, beta-adrenergic blocking agents, potassium-losing diuretics, or magnesium.Higher infusion rates may be required and duration of action may be shortened in patients receiving long-term carbamazepine or phenytoin.Route/Dosage
Availability (generic available)
Nursing implications
Nursing assessment
- Assess respiratory status continuously throughout therapy with vecuronium. Should be used only to facilitate intubation or in patients already intubated.
- Neuromuscular response should be monitored with a peripheral nerve stimulator intraoperatively. Paralysis is initially selective and usually occurs sequentially in the following muscles: levator muscles of eyelids, muscles of mastication, limb muscles, abdominal muscles, muscles of the glottis, intercostal muscles, and the diaphragm. Recovery of muscle function usually occurs in reverse order.
- Monitor ECG, heart rate, and BP throughout administration.
- Observe for residual muscle weakness and respiratory distress during the recovery period.
- Monitor infusion site frequently. If signs of tissue irritation or extravasation occur, discontinue and restart in another vein. If overdose occurs, use peripheral nerve stimulator to determine the degree of neuromuscular blockade. Maintain airway patency and ventilation until recovery of normal respirations occurs.
- Administration of anticholinesterase agents (neostigmine, pyridostigmine) may be used to antagonize the action of neuromuscular blocking agents once the patient has demonstrated some spontaneous recovery from neuromuscular block. Atropine is usually administered prior to or concurrently with anticholinesterase agents to counteract the muscarinic effects.
- Administration of fluids and vasopressors may be necessary to treat severe hypotension or shock.
Potential Nursing Diagnoses
Ineffective breathing pattern (Indications)Impaired verbal communication (Side Effects)
Fear (Side Effects)
Implementation
- high alert: Unplanned administration of a neuromuscular blocking agent instead of administration of the intended medication or administration of a neuromuscular blocking agent in the absence of ventilatory support has resulted in serious harm and death. Confusing similarities in packaging and insufficiently controlled access to these medications are often implicated in these medication errors.
- Dose is titrated to patient response.
- Vecuronium has no effect on consciousness or pain threshold. Adequate anesthesia/analgesia should always be used when vecuronium is used as an adjunct to surgical procedures or when painful procedures are performed. Benzodiazepines and/or analgesics should be administered concurrently when prolonged vecuronium therapy is used for ventilator patients, because patient is awake and able to feel all sensations.
- If eyes remain open throughout prolonged administration, protect corneas with artificial tears.
- Store in refrigerator.
- Most neuromuscular blocking agents are incompatible with barbiturates and sodium bicarbonate. Do not admix.
Intravenous Administration
- Intravenous: Reconstitute with bacteriostatic water (may be provided by manufacturer), D5W, 0.9% NaCl, D5/0.9% NaCl, or LR injection. Solution reconstituted with bacteriostatic water is stable if refrigerated for 5 days. If other diluents are used, solution is stable for 24 hr if refrigerated. Discard all unused solution.
- Concentration: Maximum of 2 mg/ml. Titrate dose according to patient response.
- Continuous Infusion: Diluent: Dilute to a concentration of 1 mg/ml in D5W, 0.9% NaCl, or LR. Use sterile water for injection instead of manufacturer-provided diluent (contains benzyl alcohol) when reconstituting for use in neonates.
- Rate: Titrate rate of infusion according to patient response.
- Y-Site Compatibility: alemtuzumab, alfentanil, alprostadil, amifostine, amikacin, aminophylline, amiodarone, ampicillin, ampicillin/sulbactam, anidulafungin, argatroban, azithromycin, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride, calcium gluconate, carboplatin, carmustine, caspofungin, cefazolin, cefotetan, cefoxitin, ceftazidime, ceftriaxone, cefuroxime, chlorpromazine, ciprofloxacin, cisplatin, clindamycin, cyclophosphamide, cyclosporine, cytarabine, dactinomycin, daptomycin, dexamethasone sodium phosphate, dexmedetomidine, dexrazoxane, digoxin, diltiazem, diphenhydramine, dobutamine, docetaxel, dolasetron, dopamine, doxorubicin hydrochloride, doxorubicin liposomal, doxycycline, droperidol, enalaprilat, ephedrine, epinephrine, epirubicin, eptifibatide, ertapenem, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentanyl, fluconazole, fludarabine, fluorouracil, foscarnet, gemcitabine, gentamicin, glycopyrrolate, granisetron, haloperidol, heparin, hydralazine, hydrocortisone sodium succinate, hydromorphone, idarubicin, ifosfamide, insulin, irinotecan, isoproterenol, labetalol, leucovorin calcium, levofloxacin, lidocaine, linezolid, lorazepam, magnesium sulfate, mannitol, mechlorethamide, melphalan, meperidine, meropenem, methotrexate, methyldopate, metoclopramide, metoprolol, metronidazole, midazolam, milrinone, mitoxantrone, morphine, moxifloxacin, mycophenolate, nalbuphine, naloxone, nesiritide, nicardipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxaliplatin, paclitaxel, palonosetron, pamidronate, pemetrexed, pentazocine, pentobarbital, phenobarbital, phenylephrine, potassium acetate, potassium chloride, potassium phosphates, procainamide, prochlorperazine, promethazine, propranolol, quinupristin/dalfopristin, ranitidine, remifentanil, sodium acetate, sodium bicarbonate, sodium phosphates, streptozocin, succinylcholine, sufentanil, tacrolimus, teniposide, theophylline, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, tobramycin, trimethoprim/sulfamethoxazole, vancomycin, vasopressin, verapamil, vinblastine, vincristine, vinorelbine, voriconazole, zidovudine, zolendronic acid
- Y-Site Incompatibility: acyclovir, allopurinol, amphotericin B cholesteryl, amphotericin B colloidal, amphotericin B lipid complex, amphotericin B liposome, busulfan, cefepime, cefotaxime, chloramphenicol, dantrolene, diazepam, etomidate, furosemide, ganciclovir, ibuprofen, imipenem/cilastatin, ketorolac, methohexital, methylprednisolone sodium succinate, micafungin, nafcillin, pantoprazole, pentamidine, phenytoin, piperacillin/tazobactam, thiopental
Patient/Family Teaching
- Explain all procedures to patient receiving vecuronium therapy without general anesthesia, because consciousness is not affected by vecuronium alone.
- Reassure patient that communication abilities will return as medication wears off.
Evaluation/Desired Outcomes
- Adequate suppression of the twitch response when tested with peripheral nerve stimulation and subsequent muscle paralysis.
- Improved compliance during mechanical ventilation.