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Adrenaline

This document provides guidelines for the use of adrenaline (epinephrine) in a neonatal intensive care unit. It details five indications for use, recommended dosages, dilutions, compatibilities and incompatibilities, monitoring needs, and adverse reactions. Adrenaline is a sympathomimetic drug used for cardiopulmonary resuscitation, hypotension, anaphylaxis, upper airway obstruction, and acute pulmonary hemorrhage in neonates. Precise dosing and administration guidelines are given to safely achieve its effects of increased heart rate, blood pressure and bronchodilation.

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Dr Islam
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201 views3 pages

Adrenaline

This document provides guidelines for the use of adrenaline (epinephrine) in a neonatal intensive care unit. It details five indications for use, recommended dosages, dilutions, compatibilities and incompatibilities, monitoring needs, and adverse reactions. Adrenaline is a sympathomimetic drug used for cardiopulmonary resuscitation, hypotension, anaphylaxis, upper airway obstruction, and acute pulmonary hemorrhage in neonates. Precise dosing and administration guidelines are given to safely achieve its effects of increased heart rate, blood pressure and bronchodilation.

Uploaded by

Dr Islam
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Te Whatu Ora – Health New Zealand Waitaha Canterbury Neonatal Services

ADRENALINE This drug must be guardrailed


Trade Name Adrenaline (generic)

Class Sympathomimetic / vasopressor

Mechanism of Action α& β receptor stimulation resulting in cardiac stimulation and


relaxation of bronchial smooth muscle
positive inotrope and chronotrope
increased systemic vascular resistance at higher doses 3

Supplied As 1:10 000 = 100 microgram/mL = 1mg/10mL


1:1 000 = 1000 microgram/mL = 1mg/mL

Indication 1: Cardiopulmonary resuscitation:


(heart rate < 80/min despite adequate respiratory support)
Dosage
ETT: 1:10000, 1mL/kg
UVC: 1:10000, 0.1mL/kg, then 0.3mL/kg, then repeat
0.3mL/kg, then 1mL/kg
Dilution Nil needed but can be diluted with saline to assist administration if
the dose is tiny
Repeat every 3-5 mins if no response to previous dose.
Interval IV bolus is the ideal route
Administration If no IV access: first 2 doses may be given down the ETT; but the
3rd dose should be IV, preferably via a UVC
Intraosseous route may be used (flush with saline).

Indication 2: Hypotension:
Dosage Low Dose 0.05 - 0.1 microgram/kg/min
High Dose 0.2 - 1.0 microgram/kg/min
Guardrail Conc Min - 0.9 microgram/mL Conc Max - 60 microgram/mL
*Must chart guardrail Soft Min: 0.02 microgram/kg/min Hard Max: 1.0 microgram/kg/min
and use Alaris pump* Soft Max: 0.6 microgram/kg/min Default: 0.05 microgram/kg/min
Dilution
Print off a separate adrenaline infusion sheet for charting and
dosing
Low Dose: Take 1.5 mL/kg (150 microgram/kg) of 1:10000
adrenaline, make up to 50mL with 5%dextrose or 0.9S
1 mL/hr = 0.05 microgram/kg/min
High Dose: Take 6 mL/kg (600 microgram/kg) of 1:10000
adrenaline, make up to 50mL with 5%dextrose or 0.9S
If >5kg will exceed max. conc. and needs to be diluted
1 mL/hr=0.2 microgram/kg/min

Interval/Administration Continuous IV infusion

Adrenaline Printed copies are not controlled and may not be the current version in use
Ref.2403096 Authorised by: Clinical Director Neonatal Page 1 of 3 September 2022
Te Whatu Ora – Health New Zealand Waitaha Canterbury Neonatal Services

Indication 3: Acute anaphylaxis:


Dosage 1:10000, 0.1 mL/kg iv
1:1000, 0.01 mL/kg subcutaneous
Dilution Nil
Administration IV bolus or subcutaneous
(Note:CDHB resus team restricts use to IM and nebulisation in adults)
Indication 4: Upper airway obstruction:4
Dosage 0. 5 mL/kg of 1:1000 diluted to 2mL with normal saline
Dilution Dilute to 2mL with normal saline
Interval Effect lasts ± 40 minutes
Administration Nebulised

Indication 5: Acute Pulmonary Haemorrhage


Dosage 0.1-0.3mL/kg
Dilution Nil needed but can be diluted with saline to assist administration if
the dose is less than 0.5mL
Administration ETT bolus and repeat every 3-5 mins until bleeding is controlled

Contraindications Arrhythmias; tachycardia > 200 beats/min.

Compatible with 0.9% sodium chloride, 5% dextrose, dextrose saline, lactated


ringer’s.
Y-site compatibility with amiodarone, amphotericin B liposomal,
benzylpenicillin, caffeine citrate, calcium chloride, calcium
gluconate, cefazolin, cefotaxime, ceftazidime, cefuroxime,
dexamethasone, digoxin, dobutamine, dopamine, erythromycin,
fluconazole, furosemide, gentamicin, heparin, hydrocortisone,
imipenem + cilastin, midazolam, milrinone, morphine, naloxone,
ondansetron, pancuronium, piperacillin and tazobactam, potassium
chloride, propranolol, prostaglandin, ranitidine, vancomycin, vitamin
K

Incompatible with Aciclovir, aminophylline, ganciclovir, phenobarbitone, phenytoin,


sodium bicarbonate, sulfamethoxazole and trimethoprim .
No information on compatibility with TPN and Lipid.

Monitoring Heart rate and BP.

Stability Single-use ampoule (no preservative).


Do not use solutions of adrenaline that are discoloured (pink or
brown).

Storage Room air < 25 degrees, protect from light.

Adverse Reactions Local injection: ischaemia and necrosis.


Adrenaline Printed copies are not controlled and may not be the current version in use
Ref.2403096 Authorised by: Clinical Director Neonatal Page 2 of 3 September 2022
Te Whatu Ora – Health New Zealand Waitaha Canterbury Neonatal Services

Systemic: arrhythmias; hypokalaemia; increased myocardial


oxygen consumption; severe hypertension, intracranial
haemorrhage; renal-vascular ischaemia; tremor.

Metabolism Hepatic via COMT & MAO enzymes.

Comments Overdose Treatment: phentolamine and propranolol


Correct hypovolaemia and acidosis prior to commencing infusion.

References 1. Shann F. “Drug Doses” Handbook 1998: Tenth Edition.


2. “Neonatal Pharmacopoeia” Handbook 1998: 1st Edition.
3. John Spence Nursery Drug Database web site
http://www.cs.nsw.gov.au/rpa/neonatal/
4. Gwinnutt C.L. et al. Letter in: Anaesthesia 1987 Mar; 42(3):320-1.
5. Trissell Handbook of injectable Drugs 10th Edition.
6. NZHPA Notes on injectable Drugs 5th Edition
7. Neofax 2013.; Micromedex
8. New Zealand Formulary www.nzf.org.nz

Updated By J Klimek, N Austin October 2001


P Schmidt, B Robertshawe May 2005
A Lynn, B Robertshawe September 2009, June 2012
A Lynn May 2013 (drop soft min after audit)
A Lynn Aug 2015 (increase soft max after audit)
A Lynn B Robertshawe March 2017 (update compatibilities)
A Lynn, M Wallenstein, B Robertshawe, A Evison May 2020
A Lynn N Austin Sept 2022 (pulmonary haemorrhage)

Adrenaline Printed copies are not controlled and may not be the current version in use
Ref.2403096 Authorised by: Clinical Director Neonatal Page 3 of 3 September 2022

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