Multiple IV Infusions

Pediatric Critical Care Columnist · May 28, 2011

Nope, no policy. In fact, we often get kids back from the OR with things running willy-nilly wherever the anaesthetist has connected them and we end up having to double-pump to get them into some sort of order. We rarely use dop but if an experienced nurse has received the patient from the OR, the nurse taking over from him or her will have the infusions in the order you've indicated, with perhaps norepi in place of the dop and a spare port for double-pumping. (Our new syringe pumps take an inordinate amount of time to change a syrninge, with multiple keys needing to be pushed to get them restarted, so double-pumping EVERYTHING going into that lumen is a must.) I was taught that you always want your pressors and squeezers in the proximal lumen with the most potent/essential proximal to the patient.

neopedsflight · May 28, 2011

Thanks janfrn,

...another question for you then, what are you using in place of the Dopamine, and when did you stop using it? Thanks so much, Tracy

Pediatric Critical Care Columnist · May 28, 2011

I've worked on my current unit for nearly 9 years and dop has never been popular. If a kid comes from the OR on it, we bump up our epi and shut off the dop. If our epi dose is getting too high (>0.1 mcg.kg/min), or if the kid is really tachy, we add in norepi. For septic shock we use norepi preferentially. We don't use much dobutamine either, preferring milrinone... to the point where we have a protocol for running it on the peds floor for kids awaiting heart transplant. It could be that because our unit is primarily a cardiovascular surgical ICU, with a side business in everything else, we avoid dop due to the side effects, especially the tachyarrhythmias.

neopedsflight · May 28, 2011

Wow, thanks so much, that is very interesting, Tracy