Implementing neuromuscular blockade monitoring in a surgical intensive care unit

Long-term infusions of neuromuscular blocking agents are being used with increasing frequency in critical care areas to paralyze patients for optimal ventilatory support or to reduce patient energy demands. Prolonged weakness with no sensory disturbance has been reported in some patients. The complex nature of the critically ill patient makes the pharmacokinetics of neuromuscular blocking agents unpredictable. Monitoring neuromuscular blockade with a peripheral nerve stimulator and administering the appropriate dose may minimize the complications of its use. The CNS can be the change agent to assist the nursing staff in incorporating recent technological innovations and research findings in nursing clinical practice. The rational model of change serves as a guide when little resistance is anticipated or when change is perceived as rational.