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

[ab1984]

I was at work and had a pt getting NS last night and then had a order for dopamine so i used the piggyback port for it to be able to give bolus that were ordered in between the dopamine. The NS was clamped and hanged lower then the dopamine. The next shift came on and was throwing a fit about the dopamine not being on its own primary line. Now mind you this pt was a hard stick and only had one IV site. She said this could cause the pt to get a bolus dose of the dopamine. Is what she said right, is not 5-10ml/hr just that regardless. If anyone can find information on this that would be great! Thanks.

[NRSKarenRN, BSN, RN]

Moved to our Nursing and Patient Medications forum.

[Sun0408, ASN, RN]

See your other post, lots of responses there.

[psu_213, BSN, RN]

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.

Yeah, I was thinking this too.

[ab1984]

Ok so I think I need to give more explanation. The dopamine was set at 10mls an hr on the top, primary, drip line of the pump, with no setting for the fluid, I just used the main IV, NS, line to run through at the piggyback port, so that when the NS was to resume I would not have to switch lines I could just clamp it and switch. The NS was not ordered at the same time. Thanks for all the info!

[ab1984]

The clamp above the pump is not a roller clamp it is a little one u slide the tube through that pinches it off.

[ab1984]

The only way I can see that the pt would get a bolus dose is if the NS was restarted at a faster rate after the dopamine was done, and I would hope that everyone that would have been doing this way would run the NS at 10 also as a flush before resuming the ordered fluid rate. Also I have found in some research that EMTs and in the ER say to not run it as a mainline.

[missnurse01, MSN, RN]

often for er or ems they usually like to have a mainline of NS going in case the pressure drops too far they can quickly bolus.

[TheCommuter, BSN, RN]

Threads merged.

[nurseladybug12]

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

[Sun0408, ASN, RN]

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.

[MunoRN, RN]

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.

[MunoRN, RN]

. 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.

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.