Double Check VASOPRESSORS Independently
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Note: Quick post.
What are VASOPRESSORS?
Vasopressors are medications that are used to assist with raising blood pressure which is important to manage in critically ill patients as it can it can lead to organ damage and even death.
There are different vasopressors based on which receptors they activate and to which extent. If your patient requires a vasopressor drip for blood pressure control, he/she should be in the intensive care unit (ICU) and receive the medication preferably through a central line.
You can always refer to your hospital’s Medication Administration Guide by Patient Care Area to find out whether a medication can be given on a certain unit.
Patients receiving DOPamine or DOBUTamine on a set rate are allowed to be on the acute care step down unit as long as titrations are managed by a physician order.
Some of the Issues with Vasopressors
| ISSUE | EXAMPLE |
|---|---|
| Wrong Concentration | • Vasopressors come in different concentrations depending on fluid restriction and dosage requirements • Make sure your patient is on the most appropriate concentration and that the pump and MAR match (e.g., norepinephrine standard 64 mcg/mL vs. double 128 mcg/mL) |
| Look-Alike/Sound-Alike | • Due to similarity in their names, ePHEDrine and EPINEPHrine, or DOPamine and DOBUTamine, can be mistaken for one another • TALLman lettering is used to differentiate between similar names • Vasopressors are HIGH-ALERT medications which require an Independent Double Check • All medication must be barcode scanned prior to administration |
| Wrong Administration Site | • All vasopressors are preferred to be administered in a central line to avoid extravasation • A more diluted phenylephrine may be appropriate for a few hours as plans for central line are discussed |
Vasopressor Titration Parameters on the MAR
The following vasopressor titration parameters are now defaulted on the MAR as follows:
| MEDICATION | DOSE ADJUSTMENTS | Contact Licensed practitioner (LIP) within 30 minutes from last dose adjustment if adjusted by more than the rate below |
|---|---|---|
| DOBUTamine | 2.5 mcg/kg/min every 5 minutes | 10 mcg/kg/min |
| DOPamine | 5 mcg/kg/min every 5 minutes | 20 mcg/kg/min |
| EPINEPHrine | 0.01 mcg/kg/min every minute | 0.3 mcg/kg/min |
| EPINEPHrine (anaphylaxis) | 0.02 mcg/kg/min every minute | 0.1 mcg/kg/min |
| norepinephrine | 0.05 mcg/kg/min every 1 minute | 0.3 mcg/kg/min |
| phenylephrine | 0.5 mcg/kg/min every 5 minutes | 2 mcg/kg/min |
