How do I prepare an epinephrine (epi) drip?

From the Guidelines

To prepare an epinephrine drip, mix 1 mg of epinephrine (1 mL of 1:1000 solution) with 250 mL of D5W to yield a concentration of 4.0 mg/mL, which is then infused at a rate of 1 to 4 mg/min (15 to 60 drops per minute with a microdrop apparatus), increasing to a maximum of 10.0 mg/min for adults and adolescents, as recommended by the most recent guidelines 1.

Preparation of Epinephrine Drip

When preparing an epinephrine drip, it is crucial to follow the guidelines carefully to ensure patient safety. The recommended concentration for adults is achieved by mixing 1 mg of epinephrine with 250 mL of D5W, resulting in a 4.0 mg/mL solution. For pediatric patients, the dosage is calculated based on body weight, with an alternative pediatric dosage by the ‘rule of 6’ being 0.6 × body weight (in kilograms) = number of milligrams diluted to total 100 mL of saline; then 1 mL/h delivers 0.1 mg/kg/min 1.

Administration and Monitoring

The epinephrine drip should be administered using an infusion pump for precise control, starting at 1-4 mcg/minute for adults and titrating based on patient response. Due to the potency of epinephrine, which stimulates alpha and beta adrenergic receptors, increasing heart rate, contractility, and peripheral vascular resistance, continuous cardiac monitoring, frequent blood pressure checks, and close observation for signs of tachyarrhythmias are essential 1.

Key Considerations

• The solution should be labeled clearly, protected from light, and used within 24 hours of preparation.
• Always double-check the calculation with another healthcare provider before administration to ensure patient safety.
• Be aware of the potential for lethal arrhythmias and the need for continuous hemodynamic monitoring when available 1.
• Consider alternative solutions and dosages for pediatric patients, and always refer to the most current guidelines and institutional protocols for the preparation and administration of epinephrine drips.

From the Research

Preparing an Epinephrine (Epi) Drip

To prepare an epinephrine drip, it is essential to understand the proper dosing and administration of epinephrine, especially in emergency settings. The following steps and considerations can be taken:

• Epinephrine is the first-line therapy for anaphylaxis, and its administration should not be delayed by the use of other medications such as antihistamines or corticosteroids 2.
• The correct dose of epinephrine should be administered intramuscularly, as intravenous administration can lead to dosing errors and cardiovascular adverse reactions 3.
• The most commonly prescribed form of epinephrine is the autoinjector, but less expensive alternatives exist, including generic autoinjectors and prefilled epinephrine syringes 4.
• Epinephrine prescriptions should be combined with action plans that guide parents and caregivers on appropriate use 4.
• In cases of anaphylaxis, immediate injection of intramuscular epinephrine is the first-line emergency treatment, and other drugs such as corticosteroids or antihistamines are secondary options 4, 2.

Important Considerations

• Epinephrine has a narrow therapeutic window, and failure to administer it promptly can result in fatalities 5.
• Education about anaphylaxis and prompt treatment are critical for patients and their caregivers 5.
• In emergency settings, training may be necessary to minimize drug dosing and administration errors and to allay concerns about the safety of epinephrine 3.
• For patients in shock, intravenous epinephrine can be used as a bolus or infusion, along with fluid resuscitation 6.