What is the proper administration protocol for dopamine (intravenous catecholamine)?

Dopamine Administration Protocol

Dopamine should be administered through a central venous catheter whenever possible, with peripheral administration only as a temporary measure using a large vein with continuous monitoring for extravasation. 1, 2

Preparation and Administration

• Prepare dopamine infusion using the "rule of 6": multiply 0.6 × patient weight (kg) to determine the number of milligrams to dilute in 100 mL of saline; at this concentration, 1 mL/h delivers 0.1 mcg/kg/min 1
• Alternatively, prepare a standard solution of 400 mg dopamine in 500 mL D5W 1
• Do NOT administer if solution is darker than slightly yellow or discolored in any other way 2
• Do NOT add sodium bicarbonate or other alkalinizing substances, as dopamine is inactivated in alkaline solution 2
• Cover the infusion container with protective foil to prevent breakdown by light 1

Administration Route

• Central venous access is strongly preferred for dopamine administration 2, 3
• If peripheral administration is necessary:
  • Use large veins of the antecubital fossa rather than veins of the hand or ankle 2
  • Use a long intravenous catheter (at least 5-cm, 20-gauge or larger) 3
  • Switch to central venous access as soon as possible 3
  • Monitor the infusion site continuously for signs of extravasation 2, 3

Dosing Guidelines

• Begin infusion at 2-5 mcg/kg/min in patients likely to respond to modest increases in cardiac force and renal perfusion 2
• For more seriously ill patients, start at 5 mcg/kg/min and increase gradually in 5-10 mcg/kg/min increments up to 20-50 mcg/kg/min as needed 2
• Dosing effects are concentration-dependent 1:
  • Low doses (<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 Requirements

• Use an infusion pump, preferably a volumetric pump, rather than gravity-regulated infusion 2
• Monitor continuously during administration 1:
  • Blood pressure (preferably with arterial line)
  • Heart rate
  • ECG
  • Urine output
• Check infusion site frequently for signs of extravasation 2, 3
• If a disproportionate rise in diastolic pressure (marked decrease in pulse pressure) occurs, decrease the infusion rate and monitor for vasoconstrictor activity 2

Managing Extravasation

• If extravasation occurs, immediately infiltrate the area with phentolamine (0.1-0.2 mg/kg up to 10 mg) diluted in 10 mL of 0.9% sodium chloride 1, 4
• Consider application of local nitroglycerin paste to prevent local ischemic injury 4

Discontinuation

• When discontinuing the infusion, gradually decrease the dose while expanding blood volume with intravenous fluids to prevent hypotension 2
• Consider oral dopamine prodrugs like docarpamine for transitioning stable patients off intravenous dopamine 5, 6

Special Considerations

• In pediatric patients with fluid-refractory shock, dopamine can be administered at 2-20 mcg/kg/min 7
• In resource-limited settings without infusion pumps, dopamine (e.g., 250 mg) can be diluted in 500 mL of crystalloid solution and infused using a drop regulator or micro-infusion set 7
• For patients with renal hypoperfusion, low-dose dopamine (2.5-5.0 μg/kg/min) is recommended 7
• For patients with pulmonary congestion, dobutamine may be preferred over dopamine 7
• In septic shock, norepinephrine may be preferred over dopamine due to less lactic acidosis 7

Cautions

• Avoid administering dopamine through the same infusion set as blood products due to risk of pseudoagglutination of red cells 2
• Exercise extreme caution to avoid accidental bolus injection, which can cause dangerous hemodynamic effects 1, 8
• Central venous pressure measurement during dopamine infusion can cause significant bolus doses and should be performed with caution 8