How to Administer Dopamine Hydrochloride

							How to Administer Dopamine Hydrochloride
Dopamine
One of the effects of asphyxia is to decrease cardiac contractility with a consequent decrease in cardiac output. If a newborn undergoes a prolonged resuscitation, including administration of epinephrine and a volume expander, and continues to have poor peripheral perfusion, thready pulses, and evidence of shock, a continuous infusion of a catecholamine may help raise the blood pressure. Dopamine hydrochloride is a catecholamine widely used with newborns for this purpose. The main effect of dopamine is to increase systemic vascular resistance, thereby raising the newborn’s blood pressure. When dopamine is required, the newborn is very sick indeed. It is suggested that a neonatologist or referral nursery be consulted at this point, if not before, about the continuing care of the newborn. Additional Considerations The administration of dopamine has some additional considerations. It must be given as a continuous infusion, with the flow rate carefully controlled with an infusion pump. Since dopamine affects cardiac output and blood pressure, the newborn receiving dopamine requires continuous monitoring and frequent assessment of heart rate and blood pressure. Indications After a prolonged resuscitation, consider the administration of dopamine if the newborn has poor peripheral perfusion and thready pulses and continues to show evidence of shock. Preparation and Administration The preparation and administration of dopamine is very different from that of other medications. Dopamine is administered only as a continuous infusion. An intravenous solution containing dopamine must be prepared.

The concentration of the solution prepared will vary based on the • Dosage desired • Newborn’s weight • Volume of fluid considered desirable or safe to administer Dosage Since dopamine is given as a continuous infusion, the dosage is always expressed as the amount of dopamine to be infused per kilogram per minute, eg, 5 g/kg per minute, not 5 g/kg or 5 g. Infusing Solution Infusing the solution at the desired mL/h provides the newborn with the desired dose per minute. Remember that an infusion pump must always be used to ensure a controlled infusion rate. Be sure to clear all the dead space in the intravenous tubing. Because the infusion rates, in terms of mL/min, are relatively slow, it may take some time before the newborn actually begins receiving dopamine if the dead space is not cleared first. Effects • Increases peripheral vascular resistance • Strengthens cardiac contractions and thus increases cardiac output to some degree • Increases heart rate and thus increases cardiac output to some degree • Raises blood pressure Expected Signs • Blood pressure should rise • Heart rate should stabilize; tachycardia often present Infusion rates are usually increased in increments of 3 to 5 g/kg/min if the blood pressure and perfusion do not improve. Consultation with a neonatologist is advised.

Follow-up First 15 minutes • Check the heart rate every 30 to 60 seconds. • Check blood pressure every 2 minutes. After 15 minutes • Check heart rate and blood pressure at least every 3 to 5 minutes until the blood pressure is stabilized.

The administration of a dopamine drip may need to be continued for several hours. As you attempt to decrease the infusion, be sure that heart rate and blood pressure stay within a normal range. Caution If newborn has an insufficient response to 20 g/kg/ min of dopamine, it is highly unlikely that raising the dose further will make a difference.