Dopamine infused by infusion pumps

moonshadeau, ADN, BSN, MSN, RN, APN, NP, CNS · Mar 17, 2006

Hello Laurent,

Yes, we do hang dopamine in bags. It comes in a concentration of 400mg/250mL as the standard concentration. We titrate it like any other drug. It is typically infused 2-20mcg/kg/min depending on objective.

suzanne4, RN · Mar 17, 2006

We have always used dopamine in pre-mixed bags from the manufacturers. Same as with dobutamine, they have longer life if made by the manufacturer than if made on the unit to begin with.

The only time that I use it in a syringe pump is with NICU and PICU patients.

We still titrate the same way that you do with your syringe pumps. We have pumps that you can calculate the same way with very small amountd infusing if need be.

fergus51 · Mar 17, 2006

Like Suzanne said, in every NICU I've worked in it's in syringes. A friend recently started training in an adult ICU and was surprised to see them in bags.

NYNewGrad · Mar 17, 2006

Yup, same deal as moonshade, 400mg/250ml bag, but I'm talking about a medsurg floor where we always hang on a pump thats preset with min and max infusion doses for drugs like these. The pts that we get on dopamine will be put on continuos BP monitoring.

Depending on the rate, the bag gets changed approx every 4 -10 hrs.

suzanne4, RN · Mar 17, 2006

Sorry, but pressors never belong on a med-surg floor. Sure they have continuous BP monitoring, but who is in the room or close by watching it?

Dopapmine and Doputamine do not belong an M/S units at all. How about telemetry monitoring that goes along with the continuous BP monitoring? How ofter are the BPs being taken?

BP needs to be charted at least every one hour for pressors if the dose is not being titrated, and at least every fifteen minutes for doeses that are being titrated. With a full load of patients, this is too much of a high acuity patient to have on the nurisng unit of that type.

TennRN2004 · Mar 17, 2006

Sorry, but pressors never belong on a med-surg floor. Sure they have continuous BP monitoring, but who is in the room or close by watching it?
Dopapmine and Doputamine do not belong an M/S units at all. How about telemetry monitoring that goes along with the continuous BP monitoring? How ofter are the BPs being taken?
BP needs to be charted at least every one hour for pressors if the dose is not being titrated, and at least every fifteen minutes for doeses that are being titrated. With a full load of patients, this is too much of a high acuity patient to have on the nurisng unit of that type.

We send our post cabgs out to the floor with Dopamine gtts at low dose (3 mcgs). At first I was surprised and kind of worried about this too. However, we haven't had any bad events, the floor nurses don't titrate the dopamine. My concern, since we make sure the pts are stable in the unit for a while with us not titrating it before they go to floor, was more that we always have central line access, but it is d/c'd before the pt goes out. The nurses run dopamine through peripherals on the floor, which is not the ideal way to infuse it. With their pt load, they can't check IV sites as frequently as we do in the unit, but so far we haven't heard anything negative about it.

LCRN · Mar 19, 2006

Suzanne,

Many med/surg floors do have continuous telemetry. My first RN job was working on a respiratory floor (considered med/surg) in which we took vented patients with either ETT/trachs, and gtts such as dopamine, dobutamine, primacor, cardizem, pronestyl and insulin (q2 hour accuchecks). We had RN/patient ratios of 1:4-5. All patients with continuous infusions of any vesicant had to have a picc/central access device. They also all had to be on telemetry. BP monitoring on these patients was done q1-2 hours with any vasoactive medications. We could only minimally titrate these drugs as well-->dopamine was only allowed at 5mcg/kg/min.

As an ICU RN with experience I still feel that these patients were taken care of and we had the proper resources day or night through a multidisciplinary team of staff members and the RN's in ICU at the time. Our patient ratio allowed us to act as a "stepdown" unit although initially we were looked upon as a regular med/surg floor with high acuity.

I hope this gives you some insight.

LCRN

Geeg · Mar 21, 2006

The problem with dopa as a pressor is that you have to turn the dose up so high to get any rise in BP, which then results in tachycardia, so then you have to switch to Levophed anyway.

pricklypear · Mar 21, 2006

Hi everybody !
I was wondering if someone could tell me how dopamine is usually infused in the USA, more precisely in ICU.
I was told it is usually prepared in bags and infused with infusion pumps, which sounds quite surprising to me, as in Europe it is prepared in syringes and infused with syringe pumps.
How is the dopamine prepared ? which mass ? in which volume ?
What are the flow rates of infusion ?
Do you manage to keep the BP constant ?
This is interesting to me, as the change of syringes is a "sensitive" time and requieres much attention, due to the short half life of this drug.
Maybe we could take some inspiration from the US medical practice...
Thanks for responses...
Laurent, from France

Hi, Laurent. Like the other posters, we generally hang dopamine in a pre-mixed bag. Pts will usually come back from surgery with syringe pumps (anesthesiology refuses to use pumps). We will usually leave them on until the pt is stable, and we're sure they won't be going back to surgery - otherwise we'll have to change them all back to syringes. I hear you about the "sensitive" time during the change of syringes. That's why I hate them with such a passion - my pressures always drop no matter how fast I can get the darn thing changed. Bags on pumps are the way to go - you don't have to stop the infusion to change bags.

versed88 · Apr 8, 2006

The hospital where I work has two different concentrations of Dopamine. 400mg/250cc is for peripheral use. We usually use 800mg/250cc...double strength to be used in central lines only.

burn out · Apr 9, 2006

In our ICU we use the 800/250 and most of our patients have central lines. We us different iv pumps than are on the floor, our pumps have computors bulit into them for any emergency drugs to perform its own rate calculation based on the dosage/volume and based on the patients weight. For example it can figure mcg/kg/min for a dopmaine drip and infuse it at however many mcgs you set it at. To adjust the drip from 4 to 5 mcgs you just type in 5 mcgs and the machine adjusts the rate.