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  DOSE Standard dilution:   200 mg Dopamine in 250 mL of D5W or NS = 800 mcg/mL Double concentration:  400 mg Dopamine in 250 mL of D5W or NS = l600 mcg/mL   Renal doses:   l-3 mcg/kg/min. Piggy back to a mainline of D5W or NS. ANY DOSE ABOVE 3 MCG/KG/MIN. WOULD NECESSITATE THE PATIENT BEING MOVED TO AN ICU OR CCU SETTING FOR CARDIAC AND HEMODYNAMIC MONITORING. Inotropic doses:  3-10 mcg/kg/min. Piggy back to a mainline of D5W or NS. Vasoprossor doses:  Greater than 10 mcg/kg/min. Piggy back to a mainline of D5W or NS. Refer to infusion chart below for rates in mL/h EX:    Patient of 60 kg an order is dopamine 2 mcg/kg/min = 9 mL/h Initiate dopamine at XX mcg/kg/min and then increase from XX mcg/kg/min every XX minutes intervals Standard infusion rate is between XXX – XXXmcg/kg/min; depending on the patient’s response to the medication. Maximum infusion rate is X.XX mcg/kg/min.  ADMINISTRATION 1. Hypovolemia and alkalotic states MUST BE CORRECTED prior to starting the infusion as per medical order. 2. Obtain baseline vital signs (blood pressure, heart rate, respiratory rate and pulse oximetry). 3. Central line is the preferred route of administration to decrease risk of extravasation. 4. Provide continuous cardiac monitoring or telemetry during administration. a. To facilite monitoring, a continuous non-evasive blood pressure machine will be used when patient is in step down unit of RVH Surgical 8. 5. Infuse via an infusion pump and use pump display menu to program the pump. 6. Adjust infusion rate according to medical order. 7. Contraindicated in patients with pheochromocytoma or patient with tachyarrhythmias or ventricular fibrillation. MONITORING • Continuous cardiac monitoring during administration. • At initiation and after each dose change monitor vital signs (blood pressure, heart rate, respiratory rate and pulse oximetry: q 5min X 3, then q 30 min X 2, then q 1 h for the duration of the therapy. • Adjust dose according to physician order based on patient response (blood pressure, cardiac output/index, central venous pressure, pulmonary capillary wedge pressure, and urine output). • Routine vital signs once the patient is stable. • If the patient has a pulmonary artery catheter: monitor cardiac output/index, central venous pressure, pulmonary artery pressure, pulmonary capillary wedge pressure and mixed venous blood gas as prescribed by physician. • Monitor for signs of cardiogenic shock such as: • hypotension (SBP less than 90 mmHg), increased PCWP/SVR/HR, decreased CO/SVO2, tachypnea, shortness of breath, heart sounds maybe diminished, may have S3 or S4, weak/thready peripheral pulse, capillary refill greater than 2 sec, cool/clammy skin, diaphoresis, oliguria, change in the mental status, metabolic acidosis. • Maintain oxygen saturation greater than or equal to 92%. • Strict monitoring of intake and output for the duration of the therapy. • After initiating the therapy, its effectiveness should be re-evaluated by attending staff. Procedure for Weaning the Infusion • Dopamine is NEVER stopped abruptly. • Decrease infusion as per physician order. Usually infusion is decreased by XXX mcg/kg/min every 15 minutes. • Monitoring of vital signs (blood pressure, heart rate, respiratory rate and pulse oximetry) during downward titration every 30 minutes during the weaning process. • Vital signs are to be repeated within 15-30 minutes post infusion. • Resume routine vital signs. • Monitor for signs of cardiogenic shock such as: • hypotension (SBP less than 90 mmHg), increased PCWP/SVR/HR, decreased CO/SVO2, tachypnea, shortness of breath, heart sounds maybe diminished, may have S3 or S4, weak/thready peripheral pulse, capillary refill greater than 2 sec, cool/clammy skin, diaphoresis, oliguria, change in the mental status, metabolic acidosis. • If the patient has a pulmonary artery catheter: Obtain cardiac output/index, central venous pressure, pulmonary artery pressure, pulmonary capillary wedge pressure and mixed venous blood gas as prescribed by physician during weaning process and within 15-30 minutes after stopping the infusion.