Dopamine for use in paediatric cardiology
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.
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...
Administer via syringe driver only.
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.
Do not administer as a bolus or undiluted.
Incompatible with bicarbonate and other alkaline solutions.
Correct hypovolaemia before commencing administration.
Do not co-infuse other infusions into the dopamine line.
Do not flush the line containing dopamine.
Solutions that are darker than slightly yellow should not be used.
Prepare a fresh solution every 24 hours.
Observation and documentation
Continuous cardiac monitoring
Monitor and document at least hourly, or as specified by the prescriber
Heart rate (HR)
Blood pressure (BP)
Oxygen saturations (SpO2)
IV site
The dose in micrograms/kg/minute is recorded on the patients observation chart hourly
The volume of infusion administered is recorded on the fluid balance chart hourly
Document renal function as urine output
Observe IV site closely and avoid extravasation. Notify medical staff immediately if extravasation occurs.
Monitor for adverse reactions
Discontinue dopamine gradually. Do not stop abruptly. Wean by increments of microgram/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
Phaeochromocytoma
Atrial or ventricular tachyarrhythmias
Hyperthyroidism
Precautions
Hypovolaemia - correct before commencing dopamine
Acidosis, hypercapnia or hypoxia - correct prior to or during administration of dopamine
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.