Vasopressin for Septic Shock

New CCU RN · Sep 14, 2003

I don't have a link to this, but I have heard that vasopressin is only clinically indicated to be used in a code situation. I know of units in my hosp that do hang it, however, from my understanding the FDA has only approved its usage in a code. My CCU does not use it other than in a code and we usually use epi over vasopressin anyhow. However I know our STICU and CSICU have hung it....

This information may be outdated, however, I heard it again at a critical care conference I attended in July.

zambezi, BSN, RN · Sep 14, 2003

I have read various articles on this and heard that it has been very effective. If you go to http://www.nih.gov and go to pubmed and type in vasopressin and septic shock, a variety of articles come up.

zambezi, BSN, RN · Sep 14, 2003

Sorry wrong web address, here is the right one: http://www.nlm.nih.gov/

neneRN, BSN, RN · Sep 14, 2003

We've hung a Vasopressin gtt on this type pt- I've seen really good results with it, but don't know of any research/studies supporting its use in this context. Generally runs at 2-6 Units/hr. The last time I hung it was a few weeks ago- pt in septic shock with BP in the toilet, already on dopamine but started taching out in 140s and still had low BP- we switched to a Vaso drip and within 5-10 minutes, SBP > 100 and normal HR in 80s.

pinkfloydfreak · Sep 18, 2003

We have heard of wonderful things on Vasopressin drips just like neneRN's but as of the moment management is working on a protocol for administrating it. It's sometimes frustrating maintaining balance between keeping BP up and preventing patients from tachying away in septic shock so, I am excited to try it. Sounds like we just added a great weapon in our orificenal of drugs in our fight to keep perfusion high in septic shock. Again thank you for all the input thus far. Hope to hear from more experiences.

Carlos RN · Apr 13, 2004

we use vasopressin for septic shock often. usually at .04 units/minute.

critcarenurse16 · Apr 13, 2004

We've hung a Vasopressin gtt on this type pt- I've seen really good results with it, but don't know of any research/studies supporting its use in this context. Generally runs at 2-6 Units/hr. The last time I hung it was a few weeks ago- pt in septic shock with BP in the toilet, already on dopamine but started taching out in 140s and still had low BP- we switched to a Vaso drip and within 5-10 minutes, SBP > 100 and normal HR in 80s.

One of our new docs ordered a vasopressin gtt for a pt in profound shock. I could not find literature on the use of vasopressin as a gtt. The doc had some handwritten notes (? from school) that he was basing his doses on-- I "talked" him out of it--refused to hang it more like it-- based on lack of info. He wanted to run a dose of 0.05 milliunits/hr---what????? This sounds like a drop in the ocean to me. The pt was already maxed on dopamine and dobutamine and was having many units RBC radiply infused. We ended up using Levophed, but the patient expired ultimately. I've used vasopressin for cardiac arrest but still feel uncomfortable about a gtt without reliable info. What do you do at your hospital? :confused:

MarkHammerschmidt · Apr 13, 2004

Yup - we use it all the time. Apparently the feeling is that it's the best first-line pressor agent for sepsis. It's not at all clear to me how it works, as it doesn't seem to be an adrenergic pressor agonist kind of thing at all. Very effective drug, .04 units/minute.

RNCENCCRNNREMTP · Apr 13, 2004

Our hospital standard is vasopressin 25units/250cc normal saline for 100mUnits/cc.

Infusion ranges is 0.01-0.08 Units/minute (6-48cc/hr)

Central line is preferred.

Good article from Anaes. Intensive Cre 29(5): 463-72 "Vasopressin and Shock"

Carlos RN · Apr 13, 2004

For septic shock dose we run vasopressin with a 10units/250ml concentration at a rate of .04units/minute (60 cc/hr).

jewelcutt · May 2, 2004

We use vasopressin in instances of septic shock, recent research suggests that doses of .01 units per minute are best. In fact I recently attended the SCCM conference and the newest research suggests it is detrimental in the long run to go over .01 units per minute(6cc/hr of a 100unit/100cc bag).

We have used it on some of our sickest open hearts for a while.

When you have heart surgery, your endogenous stores of vasopressin (our bodies produce in response to hypotensive episodes) are low, therefore a low dose continuous infusion of vaso at .01 units per minute restores whats low and decreases need for high amounts of catecholamines (Levo). Of course, we usually hang the gtt when the patient is on tons of levo (30+ mcgs) and this works really well, in fact improving urine output as well ( not sure of mechanism of action). After using high dose catecholamines for a while the body develops sort of a tolerance to them, so the vaso works well to decrease these. Vaso has saved my patients quite a few times.

We are currently conducting research at different doses of vasopressin to seee what the results are. If you want more information on vaso I suggest going into the SCCM website and looking up their recent national conference, from there order the lectures related to vasopressing(there were a few). You could also go into cleveland clinics website and look for info form last years 32nd annual dimensions in cardiac care conference. This was a great conference, more nursing based and provided good info about vaso use.