Indocin infusion

Brownbetty · Feb 22, 2004

what is his rationale for that??????? We just follow the Neofax in my institution. Sometimes the amount you draw up is so small...is it even possible to infuse such a small amount of fluid over four hours????

nicuash79 · Feb 23, 2004

The doc here orders his indocin over 4 hours.
What's up with that? Does anybody else do that? Thanks ahead of time.

We just use the Neofax reccommendations. Infuse over 45min-hour-ish

That's so strange! Plus it isn't compatible with TPN/IL so you have to have extra access for 4 hours! yuck

Gompers, BSN, RN · Feb 24, 2004

We just used to infuse it over 30 minutes, and if it was through the main IV line we'd clamp off the TPN and flush before and after the indocin. But then we changed our policy, not sure if it was our PharmD or if it was a company recommendation or what...

Since it is SUCH a small amount, it was found that if you infuse it into the IV alone for 30 minutes, it really doesn't even reach the baby, just fills the IV tubing hub, even when giving at the closest port (i.e. right next to the skin on a heplock or through the first hub in a PICC line). Then when you flush afterwards, you're flushing the indocin in all at once! Do you know what I'm saying? It took 30 minutes to fill that hub with like 0.2ml of indocin, and then by flushing it afterwards it's actually like you're giving it slow IV push because none of it has even reached the baby yet.

So what we do now is use saline to flush the heplock or clear the line of TPN, give the indocin slow IV push which really only fills the hub, then infuse 0.5ml of saline over 30 minutes to slowly push that indocin out of the hub and into the baby.

iceNICUnurse · Feb 24, 2004

So what we do now is use saline to flush the heplock or clear the line of TPN, give the indocin slow IV push which really only fills the hub, then infuse 0.5ml of saline over 30 minutes to slowly push that indocin out of the hub and into the baby.

This makes so much sense to me! I will do this next time :)

Gompers, BSN, RN · Feb 24, 2004

This makes so much sense to me! I will do this next time :)

I'd talk to your manager, neo pharmacist, and/or doctors about this. I will ask at work where this policy came from, and get back to you all.

Mofe'ny · Feb 24, 2004

Ok, Maybe this will help. I just read about this the other night. I am quotingfrom "Neonatology: Management, Procedures, on- call Problems, Diseases and Drugs" 5th edition by Tricia Lacy Gomella page128

"Several methods are currently being recommended for indomethacin therapy. ... The first is the originally described method of 3 doses being given at 12-h intervals. The second method uses the same total dosage but prolongs the indomethacin treatment over a 5 - 7 day treatment period. A third method involves a slow infusion rate for each dose given over 20 - 30 min rather than a bolus infusion. This method is believed to have a reduced effect on cerebral blood flow. Finally a fourth method uses continuous infusion. This approach is considered to have less effect for renal vasoconstriction and less PDA recurrence. Continuous IV indomethacin infusion is given at 11 ug/kg/hr for a total of 36 hours (the same total dose as for other types of infusions). The continuous infusion appears to lessen the prolblem of decreases cerebral blood flow."

At my unit we do the Q 12 hour doses X 3 doses. I think we also run our flush over 30 minutes like Gompers.

Tiki_Torch · Feb 24, 2004

Similar to what Mofe'ny found, I found this tidbit in my Neonatal Medications & Nutrition: A Comprehensive Guide, 3rd Edition by Zenk, Sills, & Koeppel on page 323 where it speaks to Administration of Indomethacin (Indocin IV):

"Although the manufacturer recommends infusion over 5-10 seconds, rapid administration may cause significant decrease in mesenteric artery and cerebral blood flow, which may contribute to development of NEC or cerebral ischemia. Hammerman and associates found that slow, continuous infusion at 11 mcg/kg/hour for 36 hours (=396 mcg/kg) was effective in closing the ductus and minimized the potential adverse effects of reduction in cerebral blood flow velocity and increase in serum creatinine, compared with an equivalent dose of 0.2 mg/kg, then 0.1 mg/kg, 0.1 mg/kg every 12 hours IV, by rapid 1-minute injection for 2 additional doses (=400 mcg/kg). Further study is needed, however, because this study had a small number of patients."

References for this information include:

Coombs RC, et al. 1990. Gut blood flow velocities in the newborn: Effects of patent ductus arteriosus and parenteral indomethacin. Archives of Disease in Childhood 65(10 spec.no.): 1067-1071.

Hammerman C, et al. 1995. Continuous versus multiple rapid infusions of indomethacin: Effects on cerebral blood flow velocity. Pediatrics 95(2): 244-248.

All in all, it seems like a good idea to give it slower if it works to close the PDA, yet doesn't have such detrimental effects on babies brain development and intestinal health... Don't we just love research that helps us take care of babies better? I wonder if any other studies have been done which correlate with the one Hammerman, et al. did.....