Inotrope policy

[yollygangemi]

Hi my name is yolly and i am a PICU nurse in australia. I am in the process of starting a project to change the inotrope policy at work especially for those bigger patients moving towards adult dosages. currently all our infusions for vasoactive medications are based on per kg in 50mls syringes until over 30kgs then change to per kg in 100ml bags for some drugs. i have heard of stardard concenration syringes for drugs that have a differing rates. I was wondering if anyone had any experience in this or would be able to supply me with their units inotrope policy and dosages plus how the infusions are made. Any help with this project would be much appreciated.

thanks in advance

Yolly

[firstlight]

hello

I have the same question also.

I also want to know what staff do for air in line when switching to bags.

[NotReady4PrimeTime, RN]

Our unit is in the process of switching from weight-based concentrations to standard concentrations to run at varying rates. It will be quite a culture change for our more senior staff. Interestingly, while we've been in-servicing the staff about the change, we've had an adult patient on the unit and have been running adult standard concentrations.

In response to your specific question about inotropes and pressors yolly, our standards will be:

Dobutamine: 1000, 2000 or 4000 mcg/mL

Dopamine: 800, 1600 or 3200 mcg/mL

Epinephrine: 12.5, 25, 50 or 100 mcg/mL

Isoproterenol: 20, 50 or 200 mcg/mL (in nearly 12 years I've never seen a patient on this!)

Milrinone: 200 or 400 mcg/mL

Nitroprusside: 200, 400 or 1200 mcg/mL

Norepinephrine: 12.5, 25, 50 or 100 mcg/mL

Phenylephrine: 25, 50 or 300 mcg/mL (rarely used)

firstlight, we don't have any straight sets for our infusion pumps that allow for air-in-line with bag changes. Everything is run through a burette. BUT... when we make this switch we'll be running these infusions on syringe pumps for most of our patients using a valved transfer set. Our NICU has been using these transfer sets for quite some time and we've been using them for heparin on our ECMO patients for about a year. If the valve is open to the bag, it's closed to the patient and vice versa. For syringe changes we'll have to assess stability of the patient and double-pump if necessary. We'll also be changing out our infusions every 24 hours. I see many issues for the first couple of months while people get used to these changes. For our bigger patients and infusions run from the bag, I guess we'll see what happens with the air-in-line alarms...