Nitroprusside/Nipride drip

We're working on a new policy for Nipride drips in our ER (level I trauma center). Before working in the ER I worked in a neuro ICU and we often used Nipride drips to keep b/p down in post op and head bleed patients. We always had an art line to titrate Nipride drips and closely monitor b/p.

There have been a few instances where I've given a Nipride drip in the ER. They even stock them in the pyxis machines (can you believe it?). I try to insist on an art line, but I don't always get it. I feel really uncomfortable titrating Nipride with a b/p cuff. I complained to my manager about it and she told me to come up with a policy.

Any experiences/opinions? Thanks!

I have found it is common practice in the ER to give a nipride drip in a peripheral IV using a BP cuff, with no art line. I set the cuff to go off every 3-5 min, and just titrate accordingly. Of course if you have an art line, that's great, but more times than not, there will be no art line available to you.