Practical considerations in the administration of intravenous vasoactive drugs in the critical care setting. Part II - How safe is our practice?

INTRODUCTION: Vasoactive drugs (e.g. inotropes), namely adrenaline and noradrenaline, are frequently used in critical care to maintain cardiovascular function. This is achieved by ensuring that a continuous infusion of the vasoactive drug is administered so that when one infusion is about to finish another infusion is commenced. This is known as "double pumping" or "piggy backing". Failure to administer these drugs appropriately may result in haemodynamic instability (hypotension and hypertension) and in extreme cases death. AIMS: The aim of this study was to evaluate current practice and identify the safest method for inotrope administration. METHODS: A series of three consecutive audits were undertaken to determine which 'Method' and 'Syringe Driver' were associated with the least adverse effects to patient blood pressure. RESULTS: The findings suggest that Modified Method 2, when used in conjunction with a high-risk syringe driver and guidelines, proved to be the safest method for 'double pumping' inotrope drugs. Modified Method 2 instructed nurses to: 'Run both syringe drivers together until a rise in systolic blood pressure is seen (>5 mmHg), then turn the near empty infusion off'. CONCLUSION: As a direct result of these audits, and the development of guidelines, inotrope administration practice on the unit has improved.