Changing vasoactive drips

umcRN, BSN, RN · Jul 13, 2012

Hmm. That depends on how unstable the kiddo is usually. Low dose dopamine? Change out the syringe when needed (we change syringes daily and tubing every 3 days). Maxed out on your dopa, epi & norepi? Run it all on separate syringes for a few hours with tubing, gather a party at your bedside (seriously, we have orders to have MD at bedside if changing vasoactives on an unstable pt) and do a quick disconnect, connect. Have fluid and epi drawn and ready just in case. I figure the more well prepared you are the better to wave off the bad juju haha.

Pediatric Critical Care Columnist · Jul 13, 2012

It really bites when you have more than one vasoactive drip that will run out in a short period of time. For kids on a higher rate of infusion I prefer to double-pump. If you took a poll though on our unit, you'd get a majority saying they just switch out the syringes as quickly as they can. Our unit doesn't have a written policy and new staff aren't even taught how to double-pump, which has resulted in major issues. We have new-to-us syringe pumps that cannot be changed out quickly like our "old" pumps can be but people don't like to go to the extra work of double-pumping. I guess they'd rather have a party at their bedside. Personally... the fewer people at my bedside the happier I am.

meanmaryjean, DNP, RN · Jul 13, 2012

We change out everything every 24 hours of course, and set up an entirely new set of pumps, let them run for a couple of hours(to 'marinade the flavors' as one of our staff puts it) then presto-chango switch them as fast as possible.

umcRN, BSN, RN · Jul 14, 2012

It really bites when you have more than one vasoactive drip that will run out in a short period of time. For kids on a higher rate of infusion I prefer to double-pump. If you took a poll though on our unit, you'd get a majority saying they just switch out the syringes as quickly as they can. Our unit doesn't have a written policy and new staff aren't even taught how to double-pump, which has resulted in major issues. We have new-to-us syringe pumps that cannot be changed out quickly like our "old" pumps can be but people don't like to go to the extra work of double-pumping. I guess they'd rather have a party at their bedside. Personally... the fewer people at my bedside the happier I am.

oh geez I would SO much rather double pump than have that party haha, pain yes but the code is going to be a lot more of a pain and paperwork!

suzy192 · Jul 14, 2012

Trying to get some concensus on the best practice for changing vasoactive drips that are delivered on med infusion pumps via a syringe. Is it a quick change out of the syringe or changing the whole syringe tubing that is already running on another pump? What do you practice?

In my unit we have a protocol to double pump if the child is unstable or on multiple inotropes. If its dopamine or dobutamine its can be just a quick change out but i like to double pump, then i get less issues. I have my new syringe set up and running but not attached for an hour prior to the change to build up pressure in the line, then attach it and clamp off the old line (i leave it connected for a while in case there are issues). I like to have someone with me at the bedside just incase, or i let the other nurses in the room know. If it was a really unstable kid i might have both infusions connected and running together (new and old) and gradually titrate rates until the old syringe is off and the new is at the full rate (ie start new syringe at 10% of rate and reduce old syringe to 90% so that patient is still getting the same dose, then titrate as tolerated). With sick kids i would let the medical staff know what i was doing so they know to come asap if needed. You get the odd accidental purge/lag now and then. I like the idea of having spare adrenaline drawn up for just incase, u can never be too careful. Most of the people in my PICU follow these techniques and we dont often have issues.

missnurse01, MSN, RN · Jul 14, 2012

wow I never knew you all did this with kids! We sure don't with adults!

Pediatric Critical Care Columnist · Jul 14, 2012

With kids we don't have the luxury of running dop at 40 mL/hr and just swapping out the bag when it gets empty. Their TFI might only be 300 mL (3 kg infant) in 24 hours... and then we restrict them to 50% of that to reduce afterload. So our vasoactive drips are highly concentrated and run at a low rate. My example baby might have epi concentrated to 18 mcg/mL and dop to 90 mcg/mL. Even the briefest of interruptions in flow (seconds!) can give you life-threatening (or at least organ-threatening) hypotension. The tiniest of inadvertent boluses (pushing the driver arm against the plunger just this hard could cause a neonate to bleed into his head. Vasoactives on tiny people have to be delivered at a steady, predictable rate which means via syringe pump. Even having something running through a different lumen in the same line that's on a volumetric pump can cause swings in their BP. We don't walk a tightrope so much as a razor's edge.