Dopamine drips in SNF?

[mercury7]

Hello, I was wondering how often dopamine drips are used in the SNF setting? Doc admitted a patient today on a 5mcg/kg/min drip with no orders to titrate (for renal perfusion). I was wondering if drips were even allowed into the SNF setting?? and, if so, whats the protocol? how often do you check VS? Help please!!

[BackfromRetirement]

Good grief! Call your pharmacist and maybe he can help.

[mamamerlee, LPN]

If you don't have a policy for this, and some decent orders, this may not have been an appropriate admission. Where's your DON on this??

[PostOpPrincess, BSN, RN]

Even at renal perfusion, that is INAPPROPRIATE.

Send him to the ER.

[brownbook]

Dopamine for renal perfusion hass been used for more than 20 years on medical floors. However the charge nurse or nursing supervisor should have had the doctor or nursing educator give an inservice to the staff. It really is safe to use under renal perfusion dosage.

[CNL2B]

Absolutely not appropriate. Someone on dopamine should be on a stepdown unit as the minimal level of care. It is a PRESSOR, for Pete's sake, and even if they are using it for renal perfusion (which is controversial), at 5 mcg/kg/min, there are pressor and inotropic effects. At a minimum, VS need to be done q1-2 hours, and UO needs to be looked at q4h, and they should be on a telemetry monitor. I doubt a SNF can provide that level of care.

[Nascar nurse, ASN, RN]

Absolutely not appropriate. Someone on dopamine should be on a stepdown unit as the minimal level of care. It is a PRESSOR, for Pete's sake, and even if they are using it for renal perfusion (which is controversial), at 5 mcg/kg/min, there are pressor and inotropic effects. At a minimum, VS need to be done q1-2 hours, and UO needs to be looked at q4h, and they should be on a telemetry monitor. I doubt a SNF can provide that level of care.

Mine can't & we are not adequately trained OR STAFFED to provide this. As an ADON in SNF.. I would have been saying "No way"! to this admission.

[HiHoCherry-O]

I would have to agree with prior posts. Why does the patient require "renal perfusion"; is the patient's blood pressure low? H/H low? If so, then those issues need to be fixed. Sounds like there is more to the picture. . .

As mentioned before, the "renal perfusion" dose of dopamine is controversial. Even so, in my experience, for those who do respond, the dopamine dose is rarely as high as 5mcg. I've seen increased output with 2mcg, but I also had a swan in and was able to gauge if my patient had adequate fluid to use in the first place.

FYI dopamine causes an increase in heart rate (even at low doses). An increase in heart rate affects blood pressure which in turn will once again affect renal perfusion. Something to think about. . .

Get your DON involved.

[ShannonRN2010, BSN, RN]

Oh my! None of the SNF I worked for would touch that pt. with a 10 foot pole!

[scoochy]

Many SNFs are desperate to fill their beds. That being said however, I would question the "decision makers" who accepted this individual for admission. Sounds to me they are not concerned about what is best for this patient; it is a huge liability for the facility and licensed personnel. Sometimes in a SNF (I work in one), your are lucky if you can find a stethescope and a functioning BP cuff...Renal dose Dopamine? I don't think so!!!

[SuesquatchRN, BSN, RN]

In NYS the ONLY IV meds that can be administered are abx.

That sounds almost like a critical care situation.

[morte, LPN, LVN]

i had a patient on a similar drug......years ago.....but she was endstage cardiac and DNR....and they only kept the drip up for a little while..