dopamine and the neonate

EricJRN, MSN, RN · Mar 23, 2006

Neofax says it's OK, unless I'm reading it wrong. Can't seem to come up with any conflicting info.

Gompers, BSN, RN · Mar 23, 2006

As far as I know, there is no reason you shouldn't be able to run dopamine along with the TPN. Why is it that you want to prove otherwise?

IV access in neonates is often a huge problem. Therefore, we make every effort to combine our IV fluids together.

prmenrs, RN · Mar 23, 2006

I would vote for having a separate IV for pressors, IF POSSIBLE. (big if). Just because if you have to titrate it, it'll be harder if it's in w/his maintanence fluids. Then, you can use the "maintanence" IV to give antibiotics, or some other push-type med.

BittyBabyGrower, MSN, RN · Mar 23, 2006

You can run Dopa with TPN. We will put Dopa with the TPN if we have a double lumen line so that we can use the other line for pushes, etc. If we have a single lumen we will start an IIP for meds, etc and run the Dopa with the TPN..central access is always preferred over peripheral. But, don't run the Dopa with TPN if you are going to be pushing meds :nono: thru that line..they will get boluses, the BP will go thru the roof then bottom out because the line isn't purged after. We have never had a problem with titrating our drips while with the TPN.

prmenrs, RN · Mar 23, 2006

Double-lumen?!!! That's cheating!!

BittyBabyGrower, MSN, RN · Mar 23, 2006

And we just started using double lumen piccs! They are da bomb! Makes life sooo much easier!

mmary2763 · Mar 24, 2006

I stated my question wrong. I know TPN is compatible with dopamine. I am just wondering about the running of TPN and dopamine thru the same port of a uvc. I feel that it causes fluctuations in blood preasure but I do not have a lot of proof. I came from a hospital that we ran nothing with dopamine. I am just trying to find some documented studies on what is the best way. Does anyone use triple port uvc thanks mary

mmary2763 · Mar 24, 2006

I stated my question wrong. I know TPN is compatible with dopamine. I am just wondering about the running of TPN and dopamine thru the same port of a uvc. I feel that it causes fluctuations in blood preasure but I do not have a lot of proof. I came from a hospital that we ran nothing with dopamine. I am just trying to find some documented studies on what is the best way. Does anyone use triple port uvc thanks mary

I think the risks of fluctuations in blood preasure is not worth it and a PIV or triple lumen uvc would be better

fergus51 · Mar 24, 2006

I have never worked at a hospital that required dopamine be run separately. I don't think that's good practice when you consider the difficulty with access and the potential for damage with infiltrates. I've seen it infused in a second lumen with only d5/hep running and seen it going only in a piv, without noticing any difference in blood pressure fluctuations. Never used triple lumen uvcs.

Why would it cause fluctuations? As long as your other fluids are running at a constant speed on a pump, you shouldn't get any dopamine boluses. Maybe you could ask your old hospital? If they required it to be run seperately, they may have had some evidence to back that up.

Gompers, BSN, RN · Mar 24, 2006

I have never worked at a hospital that required dopamine be run separately. I don't think that's good practice when you consider the difficulty with access and the potential for damage with infiltrates. I've seen it infused in a second lumen with only d5/hep running and seen it going only in a piv, without noticing any difference in blood pressure fluctuations. Never used triple lumen uvcs.
Why would it cause fluctuations? As long as your other fluids are running at a constant speed on a pump, you shouldn't get any dopamine boluses. Maybe you could ask your old hospital? If they required it to be run seperately, they may have had some evidence to back that up.

Agreed on all points.

Most of the time, we have such limited access. If it's a baby with a PCVC, we're going to need it for maintenance fluids, and it's a lot safer to run the dopamine into this line than to start a peripheral IV just for the dopamine and have it infiltrate. I've noticed blood pressure fluctuations in babies plenty of times whether it was in an IV by itself or running with maintenance fluids - some kids just have very labile pressures, period.

Even if there is a double lumen UVC or PCVC - it's still best to run the dopamine in with the maintenance fluids and leave the other lumen with just heparinized saline, so that we can use that one for all our meds. So many meds are not compatible with hyperal these days - if we used the second port for the dopamine, we'd be flushing the port with the hyperal all the time to give our meds there. It just doesn't make sense.

dawngloves, BSN, RN · Mar 24, 2006

Maybe if you have to change out the fluids you may get a bolus or maybe even no Dopa for some time? But then that could happen with a TUC too.