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

ab1984 · Dec 22, 2012

I was at work last night and I had a pt that was getting NS and then I got a order for dopamine,so I clamped the NS and lowered it then put the dopamine in the piggyback port. The next nurse came on and was mad, she said that the pt could have died because she could have gotten a bolus dose of dopamine. Is she correct? If anybody can find info or just knows about this please let me know. Thank!

Sun0408, ASN, RN · Dec 22, 2012

Dopamine and similar drugs should never be piggybacked as a secondary if I am understanding you correctly. They should be on their own primary tubing and on their own pump for proper titration. With the way you set it up, the pt also did not get the ordered fluid needed. Having both running on separate pumps would be best.

Sun0408, ASN, RN · Dec 22, 2012

DOPAMINE Guidelines for safe administration : Nursing2012

Above is a good article, easy to read and understand..

Esme12, ASN, BSN, RN · Dec 22, 2012

Titrated drips should not be "piggybacked" they should have their own line and pump. Now you may infuse it in the "main" IV line but below the pump and the dopa on it's own pump and tubing.

You also need to check with your facilities policies and procedures manual and follow that to hang, start, and titrate drips.

psu_213, BSN, RN · Dec 22, 2012

Good news: If you set the pump to the rate of the dopamine, she would not get a bolus dose of dopamine.

Bad news: she would not be getting the NSS.

iluvivt, BSN, RN · Dec 22, 2012

I am assuming you only had a peripheral line available to you at the time. Did you want to run both the NS and Dopamine ? if you still had an order to run the NS and then a Dopamine drip the best thing to do would be to start another PIV in a good vein with a small cannula away from an area of flexion and the away from a hand or wrist. It is best to give it in a central vein but can be given in a good peripheral until a central access can be obtained. Dopamine should it extravasate can cause severe tissue damage and necrosis.

It should have been set up as a primary line. If you did not need to administer the NS or for some reason could not get another PIV in place I would have done one of two actions. First, I would have added a T-ext or double extension set to my PIV if one was not already in place. Then you can continue to administer the NS and Dopamine which each set up independently as primary lines. The downside to this is that should you have an extravasation and the rate of the NS is high you have the potential to spread the Dopamine and thus its vasoconstrictive properties into a larger amount of tissue making it a bit more difficult to treat. Second,I would have just hung the Dopamine as a primary line with a volumetric pump and used a drug library if you have a smart pump. I would only do this as my last resort if indeed there was an order to continue infusing the NS,

Basically, what you did was to set up a drip as a secondary infusion or piggyback and this was not a good or safe choice nor does it meet the standard of care. I am assuming that you set your Dopamine drip up as a secondary and then set the VTBI correctly and rate of infusion so at least you some degree of safety in the set up. I can see though that this could have caused problems with a drug that may need to be titrated and could have been misidentified as something else since it was set up as a secondary. depending upon the type of pump you have and its functions I could see how a primary rate previously set could have taken over once the volume in the secondary had been infused..but again this depends on the features of your pump. Best to set up all drips such as Heparin,Dopamine,Levophed, and Dobutamine as primary infusions.

ckh23, BSN, RN · Dec 22, 2012

Good news: If you set the pump to the rate of the dopamine, she would not get a bolus dose of dopamine.
Bad news: she would not be getting the NSS.

^This.

How would the patient get a bolus of dopamine? It was on a pump, right? I don't see how the patient would have gotten a bolus dose, unless she was referring to the drug still in the line after the drip is d/c'd. Even then it is highly doubtful that would kill the patient.

Morganalefey · Dec 22, 2012

In my facility, drips like this are ALWAYS on their own pump, as a primary.

If I had needed to run the NSS as well as the dopamine, I would have had 2 pumps. The normal saline would have hooked directly to the pt saline lock, and the dopamine would have hooked into the port closest to the pt.

That is how we do it.

Sun0408, ASN, RN · Dec 22, 2012

She had the NS clamped. We do not know the VTBI she programmed for the dopamine. It normally comes in 250ml so if she programmed 150ml the pump would switch back to the primary after that amount infusing dopamine at the NS rate "thinking" it was NS. There is were the bolus could have happened. Too much room for error.

Sun0408, ASN, RN · Dec 22, 2012

The OP's tubing must be different from the ones I am familiar with. Our tubing does not have a clamp above the pump on the primary tubing, only below which would also prevent any secondary from infusing properly.

iluvivt, BSN, RN · Dec 22, 2012

Yep that is exactly what I said too! Depending on the pump type that may indeed happen.If anything event did happen because of the incorrect set up as a secondary the nurse unfortunately would be responsible. Luckily it was caught and corrected.