Download Section: 2-1

Medications – Intropic Agents Administration
Strength of Evidence Level: 3
SECTION: 16.13
__RN__LPN/LVN__HHA
PURPOSE:
To provide accurate and safe administration of inotropic
agents.
CONSIDERATIONS:
1. The goal of inotropic agents is to enhance cardiac
output.
2. Patients who cannot be weaned from intravenous to
oral therapy may require continuous infusion of
inotropic agents, such as dobutamine, milrinone,
dopamine, and amrinone.
3. The decision to continue intravenous infusions at
home should not be made until all attempts to
achieve stability have failed.
4. Specific physician orders for inotropic agents must
be obtained. The dose should be titrated and
regulated in the acute care setting prior to patient
discharge.
5. Milrinone and dobutamine may be administered on
a continuous or intermittent basis. Dopamine is
administered on a continuous basis.
6. Doses may be adjusted based on patient response,
under the direction of a physician.
7. Clinicians should consult with pharmacist about the
existence of incompatibilities prior to administration
of medications. Clinicians should be aware of the
following incompatibilities:
a. Dobutamine:
(1) Heparin.
(2) Alkaline solutions such as Sodium
Bicarbonate.
b. Dopamine:
(1) Amphotericin.
(2) Sodium Bicarbonate.
c. Amrinone:
(1) Lasix.
EQUIPMENT:
Prescribed medication(s) per specific physician’s order
Infusion device(s), pump, administration sets
Syringes
Tape
Intravenous start kit, if peripheral IV access is required
Alcohol prep pads
Gloves
Saline flush
Puncture-proof container
Impervious trash bag
PROCEDURE:
1. Adhere to Standard Precautions.
2. Identify patient and explain procedure.
3. Perform cardiac assessment prior to administration
of inotropic agents to include, but not limited to:
a.
4.
5.
6.
7.
8.
Blood pressure: if systolic blood pressure
decreases more than 10 mm Hg from baseline.
b. Pulse: if pulse increases more than 10 to 15
beats per minute, or rhythm and quality has
changed from baseline.
c. Respiratory Rate: if severity of shortness of
breath impedes treatment regime.
d. Presence or absence of edema and/or jugular
vein distention.
e. Changes in sensorium or level of
consciousness.
f. Weight gain or loss.
Notify physician of any abnormal findings or
changes from previous assessment.
Follow the specific procedures for the appropriate
venous access device.
Obtain lab work per physician orders.
Administer inotropic agents as prescribed by the
ordering physician.
Observe patient for adverse reactions and report
changes in patient’s condition to physician.
AFTER CARE:
1. Document in patient's record:
a. Procedure and observations.
b. Instructions given to patient/caregiver.
c. Response to procedure.
d. Communication with physician.