How do I administer a dopamine drip?

How to Administer a Dopamine Drip

Dopamine should be administered as a continuous intravenous infusion using an infusion pump (preferably volumetric), with the rate titrated to desired clinical effect, typically 2-20 mcg/kg/min depending on the clinical indication. 1

Preparation

• Prepare dopamine infusion using the "rule of 6": multiply 0.6 × patient's weight (kg) = number of milligrams to be diluted in 100 mL of saline; then 1 mL/hr delivers 0.1 mcg/kg/min 2
• Alternatively, use a standard solution of 400 mg dopamine in 500 mL D5W 2
• Do NOT administer if solution is darker than slightly yellow or discolored in any other way 1
• Do NOT add sodium bicarbonate or other alkalinizing substances, as dopamine is inactivated in alkaline solution 1
• Cover the bottle, burette, or syringe pump with protective foil to avoid breakdown by light 2

Administration Route

• Infuse into a large vein whenever possible to prevent infiltration of perivascular tissue 1
• Large veins of the antecubital fossa are preferred over veins of the dorsum of the hand or ankle 1
• Consider central venous access for prolonged infusions to minimize extravasation risk 3
• If peripheral administration is necessary, use a long intravenous catheter (at least 5-cm, 20-gauge or larger) 3
• Do NOT administer through ordinary intravenous apparatus regulated only by gravity and mechanical clamps 1

Dosing Guidelines

• Initial dose: Begin infusion at 2-5 mcg/kg/min in patients likely to respond to modest increments of heart force and renal perfusion 1
• For more seriously ill patients, start at 5 mcg/kg/min and increase gradually using 5-10 mcg/kg/min increments up to 20-50 mcg/kg/min as needed 1
• Dose-dependent effects 4, 2:
  • Low doses (2-5 mcg/kg/min): Primarily dopaminergic effects (renal and mesenteric vasodilation)
  • Intermediate doses (5-10 mcg/kg/min): β-adrenergic effects (increased cardiac contractility)
  • Higher doses (>10 mcg/kg/min): α-adrenergic effects (peripheral vasoconstriction)

Monitoring

• Continuous monitoring of vital signs including blood pressure, heart rate, and ECG is essential 2
• Ideally, use invasive arterial blood pressure monitoring for patients receiving higher doses 4
• Monitor urine output frequently; if it begins to decrease in the absence of hypotension, consider reducing dopamine dosage 1
• Continuously inspect the infusion site for signs of extravasation 3
• Assess for tachycardia or new dysrhythmias, which may indicate need to decrease or temporarily suspend dosage 1

Titration and Discontinuation

• Each patient must be individually titrated to the desired hemodynamic or renal response 1
• If a disproportionate rise in diastolic pressure (marked decrease in pulse pressure) occurs, decrease the infusion rate 1
• When discontinuing the infusion, gradually decrease the dose while expanding blood volume with intravenous fluids to prevent marked hypotension 1

Complications and Management

• Extravasation can cause severe tissue injury, even at low doses 3
• If extravasation occurs, inject phentolamine (0.1-0.2 mg/kg up to 10 mg diluted in 10 mL of 0.9% sodium chloride) intradermally at the extravasation site to counteract dermal vasoconstriction 4, 2
• Be aware that tolerance to renal effects may develop after 24-48 hours of continuous infusion 5
• Avoid infusion rates >20 mcg/kg/min in pediatric patients, as this may cause excessive vasoconstriction 2

Special Considerations

• In patients with fluid retention, the more concentrated solutions (1600 mcg/mL or 3200 mcg/mL) may be preferred 1
• For patients at risk of fluid overload, adjust drug concentration rather than increasing flow rate 1
• In infants with marked circulatory instability and decompensated shock, epinephrine or norepinephrine may be preferable 2