Dopamine question

suzanne4, RN · Oct 6, 2005

The facility that I am at uses syringe pumps that you do the calculations right on the pump, it automatically labels the drug. You just input the drug name, concentration that pharmacy is providing, weight of the infant, as well as rate that is ordered. You also check it via calculator and with another nurse as well.

SteveNNP, MSN, NP · Oct 6, 2005

Pharmacy sends us dopamine in 400mg/500cc concentrations, unless the MD orders some odd calculation for a kid who's fluid overloaded. That equals 800mcg/cc. We have a chart to calculate, but our Alaris pumps have a Guardrails system that calculates it for us.

Stevern21

LauRNicu · Oct 6, 2005

i can't think off the top of my head what our standard concentration for dopamine is but it is send from pharmacy ready-to-go and they can double concentrate it for fluid restricted kids. we also use the alaris pumps that do the calculation, but we ALSO have charts sent from pharmacy as a double check. love those pumps.

MamaTheNurse, BSN, RN · Oct 6, 2005

bless your hearts for being brave enough to use dopamine in babies!!! I still get nervous sometimes using it in big people!!! thank goodness for syringe pumps that calculate for you!

TiffyRN, BSN, PhD · Oct 7, 2005

First off, I generally care for the less acute babies, having only had an infant on dopamine once in 3 years of NICU. But I do know we recently changed over to standard concentration drips for dopamine. We now use 400mg/250ml. It happened just after JCAHO visited, coincidence? Anyway, we have the Alaris pumps also with the guardrails which is also a recent change. We also have backup charts from pharmacy to calculate rates as well as a formula.

BittyBabyGrower, MSN, RN · Oct 7, 2005

Premixed...we have a program on our computers that we use to get the doses and rates..all standardized now. No one should be using the rules of 6 anymore per JCAHO.

Gompers, BSN, RN · Oct 7, 2005

bless your hearts for being brave enough to use dopamine in babies!!! I still get nervous sometimes using it in big people!!! thank goodness for syringe pumps that calculate for you!

Heck, there are times I'm terrified NOT to use Domamine on these babies! I once had a baby come back from the OR with a BP of 14/9...

We used to have our Dopamine mixed up special for each baby - don't know for sure if it was the rule of 6's because I never liked that calculation. Basically, for standard concentration, it was 60mg/kg of Dop in a 100cc bag of D5W, D10W, or 0.9NS, and 1cc/hr=10mcg/kg/min. For double concentration, 120mg/kg of Dop in the bag, and 1cc/hr=20mcg/kg/min.

Now we're going to standardized concentrations, three different ones depending on the size of the baby (like a small, medium, and large dose) - so that we're generally giving between 0.1-1.0 cc/hr of fluid. We considered one standard concentration, but the bigger kids would have been getting like 2-3cc/hr of fluid and we wanted to be able to maximize the TPN rate, so we went with the three doses.

We just got inserviced on those "smart pumps" that already have the three concentrations of Dopamine in them. I think it's going to be a good change, but many of my coworkers are skeptical.

babynurse2001 · Oct 7, 2005

So I take it that there is no "standard" concentration of dopamine for babies, but none of you are actually mixing your own dopamine anymore?

I work in a small community hospital - we don't have a NICU. We transport out sick babies. I recently attended the stable course - are any of you familiar with this? - and they recommended a specific concentration of dopamine and had a chart that went with it. Unfortunately I didn't write it down...

I used to work NICU so I have a basic comfort level with little guys that most of my coworkers don't have. We almost never run dopamine on babies - generally we can get them out if we need to before it comes to that - but I shudder to think of how dangerous it would be for us to have to try to mix it ourselves and run it since we do it so infrequently. I would venture to guess most of my coworkers have never done it before.

Thanks for any more insight you guys may have!

rainbows4me · Oct 8, 2005

Our dopa/dobuta is mixed together (same syringe) in a dosage based on the kilos of the baby in either single or double strength. I think it's similar to what Gomper's described. We then have a chart that has to be posted at the bedside with the microgram/kilo rate by ml/hr. Our pharmacy (we have our own pharmacy in our NICU) mixes dopa/dobuta during the day, but we still mix our own at night. We also mix all of our iv fluids and other drips (insulin) at night. Interestingly, however, right around our last JACHO visit, they wouldn't allow us to mix our drips and took away all of our cheat sheets and supplies. We had to call down to the main pharmacy - who were CLUELESS! I had a pharmacist asking me what our formulation for certain IV fluids and drips was! Once it took 4 hours to get an insulin drip - we were beside ourselves - within a day or two after JACHO we got all of our cheat sheets and supplies back. Thank God.

BittyBabyGrower, MSN, RN · Oct 9, 2005

I've never seen Dop and Dob in the same syringe....how do you titrate it since they have different effects?

We don't make anything anymore...sometimes it totally sucks.

sunnysideup09 · Oct 9, 2005

We have standard concentrations. Dopamine is 1200 mcg/ml and dobutamine is 2400 mcg/ml. We also utilize a computer program where we put in the weight of the patient and the mcg/hr is calculated for us. Makes it very easy since we print it out and can verify the rates at the bedside.

Christine, RNC, BSN

What are you guys doing for dopamine these days? Are you using premixed solutions or are you using the rule of 6?
If you are using premixed solutions, what is the concentration? Do you have a chart that you go by to know your drip rates or are you still doing the math or both?
Thanks