Changing catecholamine infusions (technique)

[Skysurfer]

Hi 99 ers,

we are currently in the process of revising our policy regarding the management of catecholamine infusion (i.e. management of changing empty infusions via infusion pumps).

Can anyone provide me with the latest literature / technique regarding that matter?

I have read a lot about this issue (mostly anecdotal informations) and found that there exists various techniques, which are, in most cases, not based upon evidence.

Are there any practice guidelines that you´re following in your unit ?

any input is greatly appreciated .

thank you in advance

Cheers Norbert

[Barb]

Hi Norbert,
This is a very difficult issue and one that I have tried all sorts of solutions without much success. In my experience, when hanging a new catecholamine syringe, the majority of patients will experience a period of hypertension that can last as long as 40 minutes. This seems to have something to do with inserting the new connecting tubing and giving the patient a "bolus". Our unit has tried various connectors, including the "Mini Trifuse", where the catecholamine has it's own dedicated connecting spike, but without much success. We have spoken with the Mini Trifuse company for suggestions, they only mentioned not to hang the catecholamine bag or syringe below the patient to avoid hypotension. In conducting an informal survey of NICUs across the country, it appears that this problem is widespread. Several of the units do not change their catecholamine lines for 7 days to avoid these spikes during the period whent he patient is most critical and vulnerable. What I personally do when hanging these infusions is to remain at the bedside, dial up or down the infusion to try to maintain BP within ordered parameters, and adhere to minimal handling policy until patient stabalizes. Good luck and please post any information that you find. I was wondering if the adult population has similar concerns?

[ammar]

HI,
i did not find something about practical thing like this. but I will report what we do in our unit.
we begun perfusion with solution at high dilution to make acces of the patient to drugs rapid. So afater for changing lines, we use other lines and we arrest slowly the old syringue and we monitor the volume of perfused drugs that is viewed on pumps. we keep syringues for 04 days which is generally sufficient for treating shock in the most patients.