Can you use O.9NS on a mainline and dopamine on a piggyback - page 3

I would think that if you're unsure of anything in the future, be safe and ask someone else for help next time.

One IV or not, best practice is to have any pressor on its own line and pump, you can have both running into the same IV site until a second line is started or a central line is in.. I repeat, too much room for error.

If by "piggyback" you mean secondary, then the concern is that when the VTBI on the dopamine reaches zero, it will default to the primary rate. The main issue is that there isn't any reason to do this, dopamine isn't an intermittent infusion, so I'm not sure what the advantage of hanging it as a secondary would be.

If by "piggyback" you mean that you've y'd it in to a "mainline", or "carrier fluid" or whatever you want to call it, then that's fine, actually required by my facility's policy. That would essentially be two primaries running together (both are on their own pumps and they are y'd together below the pumps.

The policy at both facilities I've worked at is the opposite, dopamine MUST run with fluids at a rate of at least 100cc/hr. An extravasation can go unnoticed for longer when the infusion rate is very low, with dopamine, extravasation may not be noticed until you are seeing the early signs of tissue necrosis. When larger volumes are running, diluting the dopamine, an extravasation becomes apparent much more quickly (edema) and will typically cause the pump to alarm as the fluid compartmentalizes. Also, dopamine causes direct vasoconstriction, so infusing it undiluted can increase the risk of extravasation.

As you can see there are no absolutes. Follow your facility protocol and according to pt condition/hx. It all depends. As in the example above if the pt was in heart failure , which many of our pts are , then having fluid running more than kvo would not be contraindicated. Our fluid riders usually only go at 10-20 mls an hour. Also if dopa is going thru piv, which in itself is contraindicated but we all know it happens , then having high rates of flow will cause the iv to go bad faster...depending on the vein , the person , the rate of infusions. Op it is all highly variable so ask your resource person and look up the policy at your facility. And good luck !

Never piggy back pressors. They always go through their own line on their own channel/pump. But you're right that you give fluids before giving dopamine. Gotta have fluid in the tank for it to work!

You can however have the NS line connected to a port on, lets say, the pt's IJ, and then have the dopamine (in its own line and on its own pump) connected down to the y-site of the NS line nearest to the patient. You can do this with compatible pressors, sedatives, etc. this way you can have 4+ drips ping into a quad lumen line and all dosages are accurate.