dopamine_d_liverpool.pdf

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Liverpool Health Service Drug Administration Protocol First Issued February 2002Intensive Care Unit

Reviewed: September 2004 Page 1 of 1Review Date: September 2005 Authors: see Acknowledgements

dopamine

Policy Statement

All care provided within the Liverpool Health Service will be in accordance with infection control

guidelines, manual handling guidelines and minimisation and management of aggressionguidelines.

Medications are to be prescribed and signed by a medical officer unless required during anemergency.

Medications are to be given at the time prescribed and are to be signed by the administeringregistered nurse.

Parenteral medication prescriptions and the drug are to be checked with a second registerednurse prior to administration.

Infection Control guidelines are to be followed. All drugs administered during an emergency (under the direction of a medical officer) are to be

documented during the event, then prescribed and signed following the event. Exceptions to thisPolicy are found in Emergency Drug Dose Guidelines Policy 1.e.

Adverse drug reactions are to be documented and reported to a medical officer. Medication errors are to be reported using the hospital Patient Incident Report (CR.198) and

Medication Incident Report (ADG62). Guidelines are for adult patients unless otherwise stated.

Dopamine infusions may be titrated or weaned by Accredited RNs. Dopamine infusions are not to be purged. Medical Officers must ensure that titration and/or weaning parameters are specified on the

management plan, and have been discussed with the nurse assigned to that patient. Dopamine MUST ALWAYS be administered via a dedicated lumen of a central line, and never

piggybacked with other drugs or fluids. Where multiple infusions are required, it may beacceptable to administer dopamine together with other inotropes, via a three-way tap. Wherepossible, adrenaline should be administered separately.

Dopamine infusions must be administered by syringe pump or infusion pump. Dopamine infusions must not be administered via the drug infusion port on a haemodialysis

circuit.

For the purposes of this Policy, an accredited RN is: a Registered Nurse (RN) who has completedthe required self directed learning packages and has been accredited by an Educator/Clinical NurseConsultant, to administer/titrate inotropic drugs when caring for an Intensive Care Unit (ICU) Patient.The Educator/Clinical Nurse Consultant may deem the nurse competent if the nurse has previousdocumented experience/qualifications.

Actions

Dopamine is a naturally occurring catecholamine, vasopressor agent, a precursor of noradrenalineand adrenaline.

It stimulates the Alpha (), Beta () and possibly dopaminergic receptors [refuted3] in the sympathetic

nervous system.

1. stimulation causes peripheral, renal, splanchnic and pulmonary vasoconstriction.

2. -1 stimulation causes an increase in heart rate, contractility and excitability.

3. -2 stimulation causes peripheral vasodilation, bronchodilation.4. Dopamine-1 stimulation causes renal and splanchnic vasodilation [refuted

3]

5. Dopamine-2 stimulation inhibits the release of noradrenaline from sympathetic nerves andpromotes vasodilation [refuted

3].

These effects are proportionately different at varying dose ranges. As the dose is increased, theprevious receptors effects are gradually lost, while the effects of the new receptors are graduallyintroduced.


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ALPHA BETA 1 BETA 2 DOPA 1 DOPA 2

1-2micrograms/kg/min +++ +++

2-10

micrograms/kg/min +++ ++10-20micrograms/kg/min ++++

Dopamine inhibits sodium reabsorption in the renal tubules, thereby acting as a diuretic by promotingsodium and water excretion [refuted

3].

Indications To increase renal blood flow, to treat acute renal failure in the absence of hypovolaemia. To increase splanchnic blood flow in liver disease, GIT ischaemia, sepsis.

Contraindications Hypovolaemia. Phaeochromocytoma

Precautions Peripheral vascular disease may potentiate risk for peripheral ischaemia.

Significant Interactions Patients taking monoamineoxide inhibitors (MAOIs), or within 2-3 weeks of such treatment:

generally patients will require 1/10th of the usual dose. Dopamine contains sulfite and may cause an allergic response, particularly with patients who

have asthma. When administered with digitalis, there may be an increase in dysrhythmias

Adverse Effects In patients with high circulating renin levels (shock), efferent arteriolar vasoconstriction is a

compensatory mechanism to maintain Glomerular Filtration Rate [GFR]. Dopamine may reversethis protective mechanism and cause a paradoxical decrease in GFR.

Tachycardia, ectopic beats, anginal pain. Dysrhythmias. Tissue necrosis if extravasation from a vein occurs. Reduced blood flow to non-vital tissues, especially the skin and gut (at higher rates).

Renal vasoconstriction in the dose range may reduce renal blood flow and GFR, although thismay be offset by the overall increase in BP and cardiac output.

Hypokalaemia. Hyperglycemia.

PresentationDopamine 200mg in 5mL ampoule.


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Administration Guidelines

Dilute 200mg dopamine in 50mL sterile 0.9% normal saline to give a final concentration of 4mg/mL.

Administer1 to 3 micrograms/kg/min and observe for an increase in urine output.

Dopamine administered at dopaminergic doses may, when commencing weaning, causehypotension if there has not been adequate volume-loading.

Clinical Considerations Infusion may have a slightly pink colour discard if markedly discoloured. Syringe Change - When changing from a near completed infusion to a new syringe:

Commence new infusion pr ior to the completion of the old infusion.

Observe MAP. When this begins to rise, cease the old infusion.

Closely monitor BP.

If BP falls, increase infusion rate.

If dopamine is delivered at a high concentration/high flow rate, use a second syringe driver with adopamine infusion attached by a 3-way tap. Prior to cessation of the first syringe, commence thesecond syringe to prevent a drop in blood pressure/interruption to the infusion.


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dopamine 4000 microgram/mL infusion

(all calculations are in micrograms/kg/min, correct to 2 decimal places)

Weight (kg)

mL/hr 50 60 70 80 90 100 110 120

0.51.01.52.02.53.03.54.04.5

5.05.56.06.57.07.58.08.59.09.510.011.012.013.014.015.016.017.018.019.0

0.671.332.002.673.334.004.675.336.00

6.677.338.008.679.3310.0010.6711.3312.0012.6713.3314.6716.00

17.3318.6620.0021.3322.6724.0025.3326.67

0.561.111.672.222.783.333.894.445.00

5.566.116.677.227.788.338.899.4410.0010.5611.1112.2213.33

14.4415.5616.6717.7818.8920.0021.1122.22

0.470.951.431.902.382.863.333.814.29

4.765.235.716.196.677.147.618.108.579.059.5210.4811.43

12.3813.3314.2915.2416.1917.1418.1019.05

0.420.831.251.672.082.502.923.333.75

4.174.585.005.415.836.256.677.087.507.928.339.1710.00

10.8311.6612.5013.3314.1715.0015.8316.67

0.370.741.111.481.852.222.592.963.33

3.704.074.444.815.195.565.936.306.677.047.418.158.89

9.6210.3711.1111.8512.5913.3314.0714.81

0.330.671.001.331.672.002.332.673.00

3.333.674.004.334.675.005.335.676.006.336.677.338.00

8.679.3310.0010.6711.3312.0012.6713.33

0.300.610.911.211.521.822.122.422.73

3.033.333.643.944.244.554.855.155.455.766.066.677.27

7.888.489.099.7010.3010.9111.5212.12

0.280.560.831.111.391.661.942.222.50

2.783.063.333.613.894.174.444.725.005.285.566.116.67

7.227.788.338.899.4410.0010.5611.11

References

Carlton, J.B. 1997. The handbook of parenteral drug administration. (4th. Ed.). Williams Printers. Shepparton MIMS Online. CIAP: NSW Health Department. 1 August-31 October 2001. http://www.mims.hcn.net.au/ Low-dose dopamine in patients with early renal dysfunction: a placebo-controlled randomised trial. Australian and New

Zealand Intensive Care Society (ANZICS) Clinical Trials Group. Lancet. 356. (9248):2139-2143, December 23, 2000.

Policy Author(s) See Pharmacology Acknowledgements.docPolicy Reviewers: ICU Director, ICU CNC.

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