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Drugs - Dopamine

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For use in Ward 23B Intensive observation area (IOA)

Purpose of guideline

  • This guideline covers the use of a dopamine infusion in the ward setting.

  • Use of dopamine and the appropriate dose is to be determined by the consultant cardiologist and/or cardiac surgeon only.

  • If a dopamine infusion in the ward setting is to be considered in a neonate  (< 1 month of age) it must be done following consultation with the on-call cardiologist and PICU.

Action of medication

Dopamine hydrochloride is a synthetic catecholamine which can stimulate alpha, beta and dopamine receptors via the sympathetic nervous system. The effects of dopamine are dose dependent. At low doses (infusion rates of 0.5 to 2 micrograms/kg/min), dopamine receptors are selectively activated with renal and mesenteric vasodilatation. Renal plasma flow, glomerular filtration rate and sodium excretion usually increase with increase in urine output. The blood pressure either does not change or decreases slightly.

At infusion rates of 2 to 10 micrograms/kg/min, beta1-receptors are activated causing increased myocardial contractility and conduction velocity and heart rate and results in increased cardiac output and systolic blood pressure. The total peripheral resistance is relatively unchanged because of peripheral vasoconstriction (alpha effect) and muscle vasodilatation (beta effect).
At higher infusion rates the alpha-receptors are activated, causing vasoconstriction, and increased peripheral vascular resistance resulting in increased blood pressure. However increasing cardiac output and increasing vascular tone will cause increased myocardial oxygen demand4.

Indications

  • To correct the haemodynamic imbalance due to acute hypotension, shock, cardiac failure.
  • As an adjunct after open heart surgery, where there is persistent hypotension after correction of hypovolaemia.
  • In chronic cardiac decompensation as in congestive heart failure4.

Dose and Prescription

Dose

  • Starting dose is 5 micrograms/kg/minute administered by continuous IV infusion5. Higher doses must be discussed with a cardiologist, prior to increasing the dose.
  • *Clearance is reduced in critically ill children with renal or hepatic dysfunction.

Prescription

  • To be charted on the Fluid balance chart with a cross-reference on the drug chart stating "dopamine as per fluid balance chart".
  • Prescription on the Fluid balance chart must include:
    • amount of drug to be added, in milligrams.
    • diluent type and final volume of infusion.
    • dose in micrograms/kg/minute
    • rate in mLs/hour
    • target blood pressure (systolic and diastolic) and heart rate.

Administration

  • Give as infusion
  • Compatible fluids for further dilution - sodium chloride 0.9%, glucose 5%

Infusion preparation for child UNDER 30 kg

  • Dilute 15 mg/kg of dopamine to a total volume of 50 mLs with sodium chloride 0.9% or glucose 5%
  • Check your preparation with the example below:
Example for child weighing 5 kg
Dose  (micrograms/kg/minute) 5 micrograms/kg/minute
Amount of dopamine to  be added 15 mg x 5 Kg = 75 mg
Diluent (type and final  volume) Glucose 5% to make up to 50 ml
Rate (in mls/hour) 1 mL /hour =  5 micrograms/Kg/minute

 Infusion preparation for child 30 kg and OVER


Refer to PICU Cardiovascular Drug Infusion Chart for children over 30 kg

Administration continued...

  1. Administer via syringe driver only.

  2. In 23b - administer via central line only.
    In an emergency, if peripheral line administration is the only option, infuse via a large vein, preferably the antecubital fossa. Peripheral IV route to be approved by the cardiologist or intensivist. Observe the peripheral IV site regularly for extravasation. Request central line access as soon as possible.

  3. Do not administer as a bolus or undiluted.

  4. Incompatible with bicarbonate and other alkaline  solutions.
  5. Correct hypovolaemia before commencing  administration.
  6. Do not co-infuse other infusions into the dopamine  line.
  7. Do not flush the line containing dopamine.
  8. Solutions that are darker than slightly yellow should not be used.
  9. Prepare a fresh solution every 24 hours.

Observation & Documentation

  1. Continuous cardiac monitoring
  2. Monitor and document at least hourly, or as specified by the prescriber
    1. Heart rate (HR)
    2. Blood pressure (BP)
    3. Oxygen saturations (SpO2)
    4. IV site
  3. The dose in micrograms/kg/minute is recorded on the patients observation chart hourly
  4. The volume of infusion administered is recorded on the fluid balance chart hourly
  5. Document renal function as urine output
  6. Observe IV site closely and avoid extravasation. Notify medical staff immediately if extravasation occurs.
  7. Monitor for adverse reactions
  8. Discontinue dopamine gradually. Do not stop abruptly. Wean by increments of 1microgram/kg/minute until infusion is discontinued. Continue assessment of haemodynamic status during the weaning phase.

Special considerations

  • Handover between staff is important: discussion with medical staff needs to take place at both morning and evening handover and also between nursing staff at each shift change.

Contraindications and Precautions

Contraindications

  1. Phaeochromocytoma
  2. Atrial or ventricular tachyarrhythmias
  3. Hyperthyroidism

Precautions

  1. Hypovolaemia - correct before commencing dopamine
  2. Acidosis, hypercapnia or hypoxia - correct prior to or during administration of dopamine
  3. Pulmonary hypertension

Possible adverse effects

  • Tachycardia, chest pain, palpitations, hypotension, vasoconstriction, nausea and vomiting, headache, dyspnoea.
  • Extravasation with local pain and inflammation, and possible necrosis.
  • Disproportionate rise in diastolic pressure may indicate excessive dosage.

Drug interactions

  • Incompatible with bicarbonate and other alkaline solutions
  • Multiple drug interactions. Do not co-infuse other infusions into the dopamine line

Presentation

Dopamine Concentration (Sterile) (DBL) Infusion 200 mg/5mL.

For detailed information about dopamine hydrochloride, including clinical pharmacology, go to the New Zealand Medsafe Data Sheet. Information is also available on the NZFC.

References

  1. BNF for Children. London: BMJ Group, 2011.
  2. Paediatric Injectable Guidelines (4th ed.). Melbourne: Royal Childrens Hospital, 2011.
  3. Phelps S, Hak E, Crill C (eds.). Pediatric Injectable Drugs(9th ed.). Maryland: American Society of Health-Systems Pharmacists, 2011.
  4. Dopamine Hydrochloride [New Zealand data sheet]. Hospira NZ Wellington [updated 08//03/2012].  Available from URL:  http://medsafe.govt.nz.

  5. Woods, DJ (editor), New Zealand Formulary for Children [Internet]. 2016 [updated 2016 March 1; 2015 Sept 1; cited 2016, March 18]. Available from: www.nzfchildren.org.nz

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Document Control

  • Date last published: 29 July 2016
  • Document type: Drug Dosage Guideline
  • Services responsible: Paediatric Cardiology
  • Author(s): John Stirling, Marion Hamer, Brenda Hughes
  • Editor: Marion Hamer
  • Review frequency: 2 years