Dopamine

NicuGal, MSN, RN · Mar 20, 2015

Yes, you will see a white streak up the vessel from vasoconstriction. Dopamine infiltrates are pretty bad. Sometimes you will notice a white circle that will turn red and that line needs to get pulled. The preferred route is thru a central line.

prmenrs, RN · Mar 20, 2015

Treatment of extravasation: Dopamine hydrochloride -Â Intravenous (IV) Dilution :

"EXTRAVASATION- May result in sloughing and tissue necrosis. Use central line or large veins e.g. cephalic or basilic, to decrease risk. Treatment: Stop infusion. Restart at new IV site and notify physician. Physician to infiltrate area of extravasation with phentolamine: 5 - 10 mg diluted in 10 mL NS (adults); 0.1 - 0.2 mg/kg up to 10 mg diluted in 10 mL NS (pediatrics). Use a fine needle. To be effective, use within 12 hours."

Some docs like to leave the IV catheter in site, infuse a tiny bit of the phentolamine right @ the spot where the infiltration started, then pull the device, and then inject little spots of the phentolamine all around that spot.

Always better to pick a big vein for dopamine. If you receive a kiddo w/dopa in a hand vein, start looking for a better site asap. Dopamine infiltrations will make you check your malpractice insurance. Even if you KNOW it's not your fault. Document the heck out of these incidents!

prmenrs, RN · Mar 20, 2015

The other thing that happens when the vein in which the Dopa is being infused gets vasoconstricted, is that the baby is not getting as much drug as you think, so the effect you're looking for is reduced. Another reason not to put it in a peripheral vein.

NicuGal, MSN, RN · Mar 20, 2015

I honestly don't remember the last time we gave Dopa peripherally. But I do remember the infiltrates and sloughing and the wounds down to fascia, then the scar. Horrible. The hospital just settled those with a payout when the parents filed suit.

HyperSaurus, RN, BSN · Mar 22, 2015

I had to give dopa once peripherally. Scary

UCAFblue · Mar 28, 2015

Thanks for the replies everyone! I had the same baby back this past week and was so relieved to see that the arm/hand the PIV was in is just fine. The reason the baby didn't have a central line with the dopamine was because they were unsuccessful with a UVC...the baby ended up getting a PICC a day or so after I posted my original post, but unfortunately it was after the dopamine was discontinued. This was my first experience with dopamine...from what you've all told me it sounds like it can turn bad really quick! So, can the normal vasoconstriction eventually lead to necrosis? Or is it mostly just the infiltration you have to worry about peripherally?

NicuGal, MSN, RN · Mar 31, 2015

Usually it is just the infiltration. But if the extremity has extreme blanching you should change the site and let it rest. Always try to use a larger vessel such as an antecubital or saphenous to infuse on, especially at high doses.

Mully · Mar 31, 2015

The other thing that happens when the vein in which the Dopa is being infused gets vasoconstricted, is that the baby is not getting as much drug as you think, so the effect you're looking for is reduced. Another reason not to put it in a peripheral vein.

Why would the baby get less than what you infuse? Can you explain the mechanism behind what you mean? I'm not saying you're wrong, but I've never heard this.

prmenrs, RN · Mar 31, 2015

Because the "tube" (the vein) is narrower, the flow will be slower. (It's a physics thing?) If you increase the rate, you'll probably make the vasoconstriction worse. You could elevate the limb to help, or even massage the vein (and watch that BP jump!), but you need a new way to get the drug into the central circulation.

Don't know if I explained it very well. If you had a garden hose going, and pinched it off a little up by the spigot?

Mully · Apr 1, 2015

I see what you're saying, kind of. The physics thing I believe you're referring to is Poiseuille's law, which says (among other things) that flow is directly related to the radius of a cylinder raised to the 4th power. So although I agree which the general principle of what you are saying, I think I disagree with the idea that the baby will get less drug. As long as the heart is strong enough to pump blood through the increased systemic vascular resistance (SVR) that the dopamine is causing in the hand/arm, circulation should continue. The narrowing of the vein is analogous to the pinching off of a garden hose like you said, however as long as the heart is strong enough, the blood will burst quickly through that portion of the arm (like when you put your thumb over the end of the hose and the water shoots out far). If I'm right, the baby will get all of the drug that is infused.

Maybe I'm way off.

Does what I said make any sense? Also, is that true? You can massage the vein and watch the B/P go up? Also, does what you're saying only apply to babies or adults as well?

Thanks for the discussion.

Mully · Apr 1, 2015

All ways round, though, that baby needs a central line!