dopamine and the neonate

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I am trying to find some information or case studies that will prove that it is not a good thing to run dopamine and TPN in the same port. Anyone have any advice or comments on this subject? Mary

I guess I did not mean a seperate line. I meant a secondary port on the UVC that dopamine ran thru by itself. You are right about the rate and the TPN but what if the rate changes on the TPN or u have blood running thru secondary port and u have to push something then you are bolusing. I just wonder if there is not a better sure proof way to administer dopamine. To me it is not worth the chance of causing bleeds. What do you think?

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We don't push anything through a line that has pressors running. If we need to give blood and meds at the same time, we'll start a piv for the blood and continue to give meds through the second lumen. We usually don't run dopamine through the second port for that very reason. We save the second port for meds, blood, etc.

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Does anyone hang there dopamine differently? or use triple lumen uvc;s

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Specializes in NICU.
We usually don't run dopamine through the second port for that very reason. We save the second port for meds, blood, etc.

Right. Even if it's a double lumen UVC, we need to save that other lumen for meds and blood products. It's the same line, yes, but we need to conserve it the best we can.

We've only had a couple of triple lumen lines. They were nice, but most of the time a double lumen UVC with a single lumen UAC is just fine. Now, last month, we tried out a couple of double lumen PCVCs on some of our bigger babies. Now THAT was wonderful!!!!!!! So often, the docs act all excited about pulling the umblical lines and starting a PCVC. We don't feel so great, though, because by pulling that UVC, we're losing that precious second lumen!!!

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Specializes in NICU, PICU, educator.

I understand where you are coming from about the TPN rate, but that will not affect the Dopamine rate because it is a constant rate on the Dopamine...the TPN isn't going to pull more Dopamine thru the line because of the other pump is giving Xml/min. Does that make sense? You might get a minor fluctuation, but nothing drastic.

We have used some of the double lumen PICCs and they are awesome! We actually just put one in a kid that alread had a double lumen UVC and this kid was so sick that being on multiple drips, especially NAHCO3 our attendings decided to put it in rather than risk multiple infiltrates! This kid was Dopa, Dobut, NaHCO3, MSO4, Versed and multiple antibiotics and recing multiple infusions of blood...what a God send that line was!

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Specializes in Level II & III NICU, Mother-Baby Unit.

We usually use double lumen UVCs and piggyback the Dopamine into the TPN line closest to the baby...and...never, ever flush the TPN or Dopamine line. The TPN is going at X ml/hr and the Dopamine is going at X ml/hr so they both enter the line at the rate they need to be and flow together to the baby. We have not had a problem with fluctuating B/Ps this way so far. After hanging new Dopamine we make super-certain we have unclamped the line too!! We also put tape over the unused ports on the TPN line (so no one will accidentally cause a bolus, and we put bright stickers on the TPN and Dopamine lines alerting everyone that Dopamine is infusing!

Occasionally we have a triple lumen UVC and that's a real treat!!! We will usually use the primary port for TPN and Dopamine, secondary port for IV antibiotics and other pushes, and the tertiary port for blood or other medicines incompatible with whats going through the primary and secondary ports (like insulin, etc).

We have not used the double lumen percutaneous catheters but I'd love to see us get some! Do you know the manufacturer of your double lumen percutaneous catheters?

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I am not sure why I have such a hang up with TPN and dopamine in the same port. It just seems like at some point the dopamine could go in at an uncontrolled rate. I think it would be great to have a triple lumen uvc but I would rather run dopamine thru one port and tpn and lipids thru another and then the other port for everthing else. It just seems like to be on the safe side it would be better to run dopamine where there is not a chance of boluses that would cause fluctuations and possibly or take a risk of causing bleeds. Here is another question. Do you all filter your dopamine?

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Specializes in NICU, PICU, educator.

Yes, we filter Dopamine at our institution.

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Specializes in NICU.
I am not sure why I have such a hang up with TPN and dopamine in the same port. It just seems like at some point the dopamine could go in at an uncontrolled rate. I think it would be great to have a triple lumen uvc but I would rather run dopamine thru one port and tpn and lipids thru another and then the other port for everthing else. It just seems like to be on the safe side it would be better to run dopamine where there is not a chance of boluses that would cause fluctuations and possibly or take a risk of causing bleeds. Here is another question. Do you all filter your dopamine?

The other issue is that with the standard concentrations, sometimes the volume of dopamine is so tiny - sometimes less than 0.1ml/hr - that I would be worried that if we used one lumen purely for dopamine, that it it might clot off at such a low rate. Something to think about. About accidental boluses - if the TPN is running on a pump at a set rate, and the dopamine is on a pump at a set rate - there is no bolusing unless you access the line from elsewhere. Like another poster said - the TPN running along can't "pull" any more dopamine into the mix, it can only move along the small amounts that are secreted by the pump at whatever rate the dopamine is set at.

We used to filter our dopamine when we got it in IV bags and ran it through the infustion pumps with regular IV tubing and filters. Now that it's prepared for us in syringes to run on syringe pumps, we don't filter it anymore. I'm not worried about particles - we were worried about air bubbles in the big IV tubing. Now that it's in the syringes with microbore tubing, we can tell that there are no large bubbles, so we are comfortable infusing it without a filter.

If you first learned to give dopamine by itself, it's understandable that you're having a hard time accepting that other places run it with the TPN. It's normal to have a hard time with change, because when we first learn something, we assume it's the "right" way so if someone else does it differently, then their way must be the "wrong" way. It happens in every hospital, every office, every factory, EVERYWHERE. Someone new comes in and it's hard because they want to say, "But where I used to work they did it THIS way, not THAT way," and again that's completely normal. It takes some getting used to. But on this particular topic, I don't think you're going to get your hospital to change. Running dopamine drips with TPN is pretty standard NICU practice across the country, as we've seen in this thread.

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Specializes in NICU.

We use double lumen UVC's, and I like to double spike my TPN, so I don't have to keep giving heparin flushes to one lumen. If we have calcium gluconate boluses, we have to stop the tpn while that infuses. I've run dopamine in one lumen with half the tpn, then used the other side for meds, to be infused with the other half of the tpn running. Any more infusions, and I start a PIV.

I'm going to work now, I'm working half a shift tonight!

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I appreciate your imput on this subject. I really think you are right about getting the institution to change. Do you know of any resources on all of the dopamine subjects? mary

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