Levophed Bolus

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Recently during a code situation that involved a pt's RCA and V-Fib we maxed out on our Neo gtt, Epi gtt, and Levo gtt. We were then giving 3-5 minute bolus of epi and neo just keep his pressure up. I requested to the MD that we give a Levo bolus and suggested 32mcg or 2 mls. The bolused worked wonderful. Has anyone else seen this occur or heard of a Levo bolus.

Jonathan RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
All I know is that this was a lot of Alpha to have Neo, Epi and Levo.

Jonathan

The patient probably doesn'/didn't have the best prognosis.

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Specializes in SICU, MICU, BURN ICU, Trauma, CTICU, CCU.

I've only seen levo boluses used here and there, but we push sticks of neo all the time for acute hypotension in patients who are either maxed on their vasoactives or while we are getting the bags mixed. Works really well in a pinch!

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Specializes in GICU, PICU, CSICU, SICU.

In our hospital we sometimes use small amounts of levophed in bolus when the situation turns dire and we are about to go into a code (32 - 64 mcg as a maximum). Sometimes it is used when switching the levo drip when we know they are very dependent to prevent an extremely low BP.

In pedes cases we hardly ever use Levo as they are prone to reflective bradycardia when administering levo. We prefer Neo or epi in children for this reason.

Correct me if I'm wrong but when I was still in nursing school we were thought dosages for epi and norepi were interchangeable during a code but I can't support this statement with ALS guidelines (mostly because it is 2am here and it seems like too much work).

Anyway these were my thoughts on the matter.

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