Liverpool Health Service Intensive Care Unit

Drug Administration Protocol

First Issued February 2002

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 aggression guidelines. Medications are to be prescribed and signed by a medical officer unless required during an emergency. Medications are to be given at the time prescribed and are to be signed by the administering registered nurse. Parenteral medication prescriptions and the drug are to be checked with a second registered nurse 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 this Policy 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 be acceptable to administer dopamine together with other inotropes, via a three-way tap. Where possible, 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 completed the required self directed learning packages and has been accredited by an Educator/Clinical Nurse Consultant, 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 previous documented experience/qualifications.

Actions
Dopamine is a naturally occurring catecholamine, vasopressor agent, a precursor of noradrenaline and adrenaline. It stimulates the Alpha (), Beta () and possibly dopaminergic receptors [refuted3] in the sympathetic nervous system. 1. 2. 3. 4. 5. stimulation causes peripheral, renal, splanchnic and pulmonary vasoconstriction. -1 stimulation causes an increase in heart rate, contractility and excitability. -2 stimulation causes peripheral vasodilation, bronchodilation. Dopamine-1 stimulation causes renal and splanchnic vasodilation [refuted3] Dopamine-2 stimulation inhibits the release of noradrenaline from sympathetic nerves and promotes vasodilation [refuted3].

These effects are proportionately different at varying dose ranges. As the dose is increased, the previous receptors effects are gradually lost, while the effects of the new receptors are gradually introduced.
Reviewed: September 2004 Review Date: September 2005 Page 1 of 1 Authors: see Acknowledgements

Liverpool Health Service Intensive Care Unit

Drug Administration Protocol

First Issued February 2002

ALPHA 1-2 micrograms/kg/min 2-10 micrograms/kg/min 10-20 micrograms/kg/min

BETA 1

BETA 2

DOPA 1 +++

DOPA 2 +++

+++ ++++

++

Dopamine inhibits sodium reabsorption in the renal tubules, thereby acting as a diuretic by promoting sodium and water excretion [refuted3].

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 reverse this 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 this may be offset by the overall increase in BP and cardiac output. Hypokalaemia. Hyperglycemia.

Presentation
Dopamine 200mg in 5mL ampoule.

Reviewed: September 2004 Review Date: September 2005

Page 2 of 2 Authors: see Acknowledgements

Liverpool Health Service Intensive Care Unit

Drug Administration Protocol

First Issued February 2002

Administration Guidelines
Dilute 200mg dopamine in 50mL sterile 0.9% normal saline to give a final concentration of 4mg/mL. Administer 1 to 3 micrograms/kg/min and observe for an increase in urine output. Dopamine administered at dopaminergic doses may, when commencing weaning, cause hypotension 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 prior 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 a dopamine infusion attached by a 3-way tap. Prior to cessation of the first syringe, commence the second syringe to prevent a drop in blood pressure/interruption to the infusion.

Reviewed: September 2004 Review Date: September 2005

Page 3 of 3 Authors: see Acknowledgements

Liverpool Health Service Intensive Care Unit

Drug Administration Protocol

First Issued February 2002

dopamine 4000 microgram/mL infusion

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

Weight (kg) mL/hr 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 5.5 6.0 6.5 7.0 7.5 8.0 8.5 9.0 9.5 10.0 11.0 12.0 13.0 14.0 15.0 16.0 17.0 18.0 19.0 50 0.67 1.33 2.00 2.67 3.33 4.00 4.67 5.33 6.00 6.67 7.33 8.00 8.67 9.33 10.00 10.67 11.33 12.00 12.67 13.33 14.67 16.00 17.33 18.66 20.00 21.33 22.67 24.00 25.33 26.67 60 0.56 1.11 1.67 2.22 2.78 3.33 3.89 4.44 5.00 5.56 6.11 6.67 7.22 7.78 8.33 8.89 9.44 10.00 10.56 11.11 12.22 13.33 14.44 15.56 16.67 17.78 18.89 20.00 21.11 22.22 70 0.47 0.95 1.43 1.90 2.38 2.86 3.33 3.81 4.29 4.76 5.23 5.71 6.19 6.67 7.14 7.61 8.10 8.57 9.05 9.52 10.48 11.43 12.38 13.33 14.29 15.24 16.19 17.14 18.10 19.05 80 0.42 0.83 1.25 1.67 2.08 2.50 2.92 3.33 3.75 4.17 4.58 5.00 5.41 5.83 6.25 6.67 7.08 7.50 7.92 8.33 9.17 10.00 10.83 11.66 12.50 13.33 14.17 15.00 15.83 16.67 90 0.37 0.74 1.11 1.48 1.85 2.22 2.59 2.96 3.33 3.70 4.07 4.44 4.81 5.19 5.56 5.93 6.30 6.67 7.04 7.41 8.15 8.89 9.62 10.37 11.11 11.85 12.59 13.33 14.07 14.81 100 0.33 0.67 1.00 1.33 1.67 2.00 2.33 2.67 3.00 3.33 3.67 4.00 4.33 4.67 5.00 5.33 5.67 6.00 6.33 6.67 7.33 8.00 8.67 9.33 10.00 10.67 11.33 12.00 12.67 13.33 110 0.30 0.61 0.91 1.21 1.52 1.82 2.12 2.42 2.73 3.03 3.33 3.64 3.94 4.24 4.55 4.85 5.15 5.45 5.76 6.06 6.67 7.27 7.88 8.48 9.09 9.70 10.30 10.91 11.52 12.12 120 0.28 0.56 0.83 1.11 1.39 1.66 1.94 2.22 2.50 2.78 3.06 3.33 3.61 3.89 4.17 4.44 4.72 5.00 5.28 5.56 6.11 6.67 7.22 7.78 8.33 8.89 9.44 10.00 10.56 11.11

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) Policy Reviewers:

See Pharmacology Acknowledgements.doc ICU Director, ICU CNC.

Reviewed: September 2004 Review Date: September 2005

Page 4 of 4 Authors: see Acknowledgements