Hanging dopamine and preventing accidental bolus

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I am a new NICU nurse. Whenever I hang IV dopamine I always end up giving the patient an unintentional bolus when I am changing their IV bag for the night. I was told not to use the roller clamp because it can give them a bolus. But I feel like once you unclamp the tubing, it will give the baby bolus anyway. Does anyone have a special technique they use when they are hanging their dopamine that will prevent the babies from getting a bolus? Thanks!

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We use syringe pumps on my unit, if a baby is very sensitive and unstable we will gather a new pole and pumps for everything we are hanging, we will string everything together and run it all for 20 minutes or so then quickly change the whole thing out, the baby may still fluctuate a bit but it seems to be the best way. If you can't run everything then at least the pressors should be ready and running for a while before hanging them

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run it on a pump?:confused::confused: sorry id ont work with neonates :D

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Specializes in Emergency & Trauma/Adult ICU.

I don't work NICU, but I'm not understanding how this happens -- surely a pressor is on a pump??

When changing bags of drips I frequently don't even stop the pump unless it's running really fast. As long as there's a little fluid in the drip chamber, nothing is affected in the few seconds it takes to disconnect the tubing from the completed bag & spike it into a new bag. The pump never knows the difference, other than simply re-programming the volume.

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We hang our dopamine using the IV bags. After I change out the fluids and tubing (we change them q24 hours), the minute I release the clamp and press START on the channel, i see the baby's MAPs rise for at least 5 min. The MAP eventually goes back down after i pause the dopa for several minutes. But I mainly want to prevent the bolus from happening in the first place. Should I hang all of my new bags, let them run and THEN connect it on the patient? I usually pause all of the fluids first, disconnect the old tubing from the patient, connect my new tubing to the patient, then string the new tubing in to the pump and set my pumps. Am i doing it wrong?

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Specializes in Med/Surg.
We hang our dopamine using the IV bags. After I change out the fluids and tubing (we change them q24 hours), the minute I release the clamp and press START on the channel, i see the baby's MAPs rise for at least 5 min. The MAP eventually goes back down after i pause the dopa for several minutes. But I mainly want to prevent the bolus from happening in the first place. Should I hang all of my new bags, let them run and THEN connect it on the patient? I usually pause all of the fluids first, disconnect the old tubing from the patient, connect my new tubing to the patient, then string the new tubing in to the pump and set my pumps. Am i doing it wrong?

Ah I think I see what you are saying. The way our pumps work, in order to get them to latch in it does push a small amount of extra fluid out. I would try getting the system all hooked up, bag to tubing into pump and then connecting it to the patient to see if that makes a difference.

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We hang our dopamine using the IV bags. After I change out the fluids and tubing (we change them q24 hours), the minute I release the clamp and press START on the channel, i see the baby's MAPs rise for at least 5 min. The MAP eventually goes back down after i pause the dopa for several minutes. But I mainly want to prevent the bolus from happening in the first place. Should I hang all of my new bags, let them run and THEN connect it on the patient? I usually pause all of the fluids first, disconnect the old tubing from the patient, connect my new tubing to the patient, then string the new tubing in to the pump and set my pumps. Am i doing it wrong?

I know nothing about NICU, but I'm curious.....Are you using an IV pump, or is it a gravity bag (counting gtt/minute)?

I'm confused because I see you mention a roller clamp and a start button.....our IV tubing has one or the other (roller clamp on gravity bag but not on plumb tubing for the pump).

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Specializes in Burn, CCU, CTICU, Trauma, SICU, MICU.

I don't have an answer for you, I just have to give you props for working with a patient population that would is so sensitive as to notice the slightly fluid push from the slide of a roller clamp!!!!

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Specializes in NICU, PICU, PACU.

We dont' have enough pumps to do what the other nicu person suggested,. My advice is to get it all primed and ready to go, get the old set out fast, hook the new one up and start it before you connect it to the line. It is kind of inevitable that they get a small bolus, but everything should be ready to go...and release the roller clamp as soon as you get it in the pump not when it is hooked to the patient. We hang ours on syringe pumps so we don't have to worry about the roller.

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Specializes in Emergency & Trauma/Adult ICU.

I just can't picture what you're saying. Maybe this is a better question for another nurse on your unit who is familiar with your pumps.

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I don't have an answer for you, I just have to give you props for working with a patient population that would is so sensitive as to notice the slightly fluid push from the slide of a roller clamp!!!!

when your patient weighs 1kg and your running 20mcg/kg/min the smallest .1 or .2mls can make quite the difference in pressure swings

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