Epi Drips

Peak

ED/Prehospital Registered Nurse
543
283
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Perhaps the term piggy back might mean different things to different people. To me piggyback drips are running as a secondary while your primary fluid using the differential gravitational force to drive the secondary fluid in lieu of the primary fluid. I guess you could mess the with the secondary clamp but I would personally rather just string up a second line with your chaser. If you change the gravity on your bags at all it can change the differential rate which gravity pushes in your primary and secondary on your piggyback.

In the world of critical care we almost never use piggyback as a way of delivering any medicaitons (with the exception of as a flush for chemo, antibiotics, etc...). Rather medications that are necessitate a strict rate are given on a independent primary drip set.

Without a chaser any changes to drip rate are going to be delayed by whatever the priming volume is on the set. If you are in theory only running one drug through a site that isn't a problem, but if you are running more than one drug you start to end up with some weirdness between wherever your meds Y-site and the actual infusion site, in some cases this can be several mLs. Even a priming volume of 0.5 mL with a drip rate of 0.33 mL/hr ends up being over an hour before the change may reach the patient. The chaser fluid helps to mitigate this by over all increasing the infusion rate without increasing the amount of drug given so that any changes are quicker in effect.
 

justin1232

Forum Lieutenant
241
45
28
Symptomatic Brady, hypotensive refractory to fluid, rosc ( but different dosage).

Was taught 1mg of 1mg/10ml epi. In 250ml bag. Equal 4mcg/ml.
Brady/hypotension infuse 2-10 mcg/min

Rosc will be 0.1 to 0.5 mcg/kg/min.

But area recently hired in doesn’t use epi drips and instead has push dose epi.
 

E tank

Caution: Paralyzing Agent
820
630
93
Symptomatic Brady, hypotensive refractory to fluid, rosc ( but different dosage).

Was taught 1mg of 1mg/10ml epi. In 250ml bag. Equal 4mcg/ml.
Brady/hypotension infuse 2-10 mcg/min

Rosc will be 0.1 to 0.5 mcg/kg/min.

But area recently hired in doesn’t use epi drips and instead has push dose epi.
You mean .01-.05 mcg/kg/min?
 

E tank

Caution: Paralyzing Agent
820
630
93
Wait no haha it is 0.1 to 0.5 mcg/kg/min basing off ACLS guidelines that is.
You're right. Sorry. That is a lot of epi. I don't go by ACLS guidelines. I would say that a generic start to post ROSC hypotention of 0.1 is a little heavy handed...but they didn't ask me, so there's that.

In my patient population (cardiothoracic/vascular) if I have someone on 0.1 mcg/kg/min of epi, the patient us unusually unstable. But that is also in the contexts of the other drips I have available to me that will mitigate the need for so much.

A quick and dirty way to get a drip started quickly to buy yourself time to get your bearings and settle into a plan is to add one vial of any inopressor you're interested in to 250 cc of fluid (in this case epi, which should be 1 mg) and start it at 30 drops a minute.

So that will give you 4 mcg/min or .05 mcg/kg/min in an 80 kg patient. It's enough to get you started.

If you do that for norepi, you get 0.1/kg/min or 8 mcgs/min...
vasopressin...2.4 units/hour...
dopamine (1 vial of 400mg)....10/kg/min

If some doses are a little heavy handed or not aggressive enough, titrate up or down once you get your bearings. The point is to get it rolling and working without a lot of analysis and go from there.
 
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