Description and indication for use
Adrenaline is a sympathomimetic agent that acts
directly on alpha (α) and beta (β) adrenergic receptors. It initiates all
actions of the sympathomimetic nervous system, except those on the arteries of
the face and the sweat glands.
Adrenaline is a powerful cardiac stimulant
and is used to improve cardiac output and increase systemic blood
pressure. Adrenaline infusions are used
for circulatory collapse not due to hypovolaemia. The main effects of therapeutic parenteral
doses of Adrenaline are relaxation of smooth muscle of the bronchial tree,
cardiac stimulation and constriction of cutaneous vasculature.
Dose
Cardiac arrest:
IV stat:
0.01 to 0.03 mg/kg/dose (0.1 to 0.3 mL/kg/dose
of 1:10,000) repeated every 5 to 10 minutes PRN.
Subsequent doses of 0.1 mg/kg/dose (1 mL/kg/dose
of 1 in 10,000) may be repeated as necessary (if no response).
Endotracheal (ET) (if no IV access):
0.05 to 0.1
mg/kg/dose (0.5 to 1 mL/kg/dose of 1:10,000).2
(DO NOT follow
with sodium chloride 0.9% flush).
Post
extubation Stridor/Bronchospasm
NEBULISER:
Use
1:1,000 0.5ml/kg/dose 4-6 hourly.
Hypotension:
IV infusion:
0.05 to 1
microgram/kg/minute.1-3
(Higher doses of Adrenaline may be used but the risk of side effects increases significantly.)
Route and method of administration
Ampoule = 1 in
10,000 (1 mg/10 mL) or 1 in 1,000 (1
mg/mL).
IV injection and ET:
Use 1 in
10,000. No dilution necessary.1, 2
IV infusion:
Withdraw ordered
dose from (1 in 1,000 [1 mg/mL]) ampoule and make up to volume with ordered
infusion fluid.
Suitable
infusion fluids are Glucose 5%, Glucose 10%, Sodium chloride 0.9% and Glucose/Sodium
chloride combinations.6-8
Usual order will
be as follows:
| Drug | How to make up | Dose equivalent | Dose range |
| Adrenaline | 0.6 mg/kg in 50 mL of Glucose 10% | 1 mL/hr - 0.2 microgram/kg/min | 0.05 - 1 microgram/kg/min |
Protect
undiluted solution from light 7
Side effects
Hypokalaemia.
Renal vascular ischaemia with decreased
urine formation.
Restlessness.
Reactive hyperaemia.
Hyperglycaemia (inhibition of insulin
secretion and conversion of glycogen reserves).
Vasoconstriction with poor peripheral
tissue perfusion, cold extremities – this makes perfusion (capillary refill) as
a measure of volume status very difficult.
In high doses: hypertension, arrhythmias,
cerebral haemorrhage, pulmonary oedema.
Special precautions
Correct hypovolaemia and acidosis before
commencing Adrenaline as an infusion.2
Compatibilities
| Amikacin | Heparin | Pancuronium |
| Calcium gluconate | Hydrocortisone Sodium Succinate | Potassium Chloride |
| Dobutamine | Midazolam | Noradrenaline |
| Dopamine | Milrinone | Ranitidine |
| Frusemide | Morphine |
|
Incompatibilities
Adrenaline rapidly
decomposes in alkaline conditions, therefore it is incompatible with Sodium Bicarbonate.
Other incompatible medications: Aminophylline, Vancomycin.
Discoloured solutions
should NOT be used.
Contact Pharmacy if further
information is required.
Drug Interactions
|
Adrenaline
|
Can cause arrhythmias,
hypertension and vasoconstriction; risk is increased by administration
with other medications that also have arrhythmogenic, hypertensive or
vasoconstrictive effects. Use
combination cautiously and monitor ECG, blood pressure (BP) and haemodynamic
parameters as appropriate.
If Adrenaline is given with a non-selective alpha-blocker
(Phenoxybenzamine, Phentolamine) hypotension, rather than an increase in BP,
may occur.
|
|
Beta-blockers and adrenaline
|
Vasoconstrictor effects of Adrenaline
predominate; marked hypertension followed by reflex bradycardia.
Less marked with
selective beta-blockers (eg. Atenolol, Metoprolol).
Reduce
Adrenaline dose if using a non-selective beta-blocker (eg. Propranolol, Ccarvedilol).
|
Nursing responsibilities
Cardiorespiratory monitor.
Monitor blood pressure, preferably with
arterial line.
Infuse alone if IV access will allow. If
running as a multiple infusion, care should be taken to avoid bolus dosing.
Do not give boluses.
Change syringe every 24 hours and tubing
every 3 days as per RCH IV Line Protocol.
Ensure 3 way tap in off position whilst changing syringes/lines.
No medications are to be administered into Adrenaline infusion.
Observe infusion site carefully for signs of infiltration / ischaemia.
Do not suddenly stop or interrupt infusion,
dose should be weaned slowly.
Measure urinary output.
Protect undiluted solution from light. Do NOT use if solution is discoloured.
Check that rate ordered corresponds with
dose required (micrograms/kg/min).
References:
1. RCH Paediatric Pharmacopoeia,
13th ed. 2002.
2.
RWH Neonatal Pharmacopoeia, 2nd
ed. 2005.
3.
Frank Shann, Drug Doses, RCH,
15th ed. 2010.
4.
Thomas Young et al. Neofax,
22nd ed. 2009.
5.
British National Formulary for
Children, 2013 – 2014.
6.
RCH Paediatric Injectable
Guidelines, 4th ed. 2011.
7.
Australian Injectables
Handbook, SHPA, 5th ed. 2011.
8.
Lawrence Trissel, Handbook on
Injectable Drugs, 17th ed. 2013.