Changing catecholamine infusions - blood pressure drops unavoidable?

[Francesco Cardona]

We are having an ongoing discussion on our ward about blood pressure drops when changing catecholamine infusions (dopamine, adrenaline..). We often observe that even if new infusions are slowly started while slowly discontinuing the old infusion (over a couple of hours) we encounter drops in blood pressure every so often. Some argue that it is best to just quickly exchanging the syringe is just as effectful in mainting adequate pressure.

What are your experiences with that? how do you deal with this issue?

[Guest JoannieO]

We set up the new infusion on a separate pump and run it at the prescribed rate for 1 - 2 minutes. Then the baby's line is clamped to maintain the pressure in the line, the old infusion disconnected, the new one connected and the line unclamped. The aim is to maintain pressure in the line as much as possible and to make the change as quickly as possible, so preparation is really important. However, even doing this we find that there are some babies who are very sensitive to changes in the line pressure and there can still be minor drops in blood pressure, but this works quite well for us.