Description and indication for use:

Atropine is an anti-cholinergic agent having effects on smooth muscle, cardiac muscle and various glandular cells.  It causes increased heart rate, reduced gastrointestinal motility and tone, urinary retention, cycloplegia and reduced salivation and sweating.  It is used to treat bradycardia and for cardiopulmonary resuscitation.  It may also be used in conjunction with neostigmine for reversal of muscle relaxation due to pancuronium.

May be used prior to intubation to reduce incidence of bradycardia and therefore maintain cerebral perfusion during procedure.

Dose

IV and IM:

20 micrograms/kg/dose (may be repeated in 5-10 minutes).

ETT: (when IV route not available)

2 - 3 times IV dose followed by 1 mL of sodium chloride 0.9%.

Reconstitution/Dilution

Ampoule = 0.6 mg in 1 mL (600 micrograms/mL).

IV 1:

For Intubation pre-med dose please see neat dosing guidelines in Medicines for Intubation and Resuscitation Quick Reference Guide page 121 [Appendix C].

IV 2:

Withdraw 0.2 mL of 600micrograms/mL solution and add to 1 mL of sodium chloride 0.9% in a second 2 mL syringe = 120 micrograms/1.2 mL = 100 mcg/mL.  

Discard excess volume to obtain required dose or withdraw dose using another 1 mL syringe.

Route and method of administration

IV:

Give over 1 minute.

Peak increase in heart rate occurs 2-4 minutes.

Special precautions

Compatibilities

Glucose 5%.

Glucose 10%.

Sodium chloride 0.9%.

TPN

Incompatibilities

Do not mix with sodium bicarbonate

Atropine sulphate must not be mixed with the following drugs:

adrenaline, ampicillin, heparin sodium, thiopentone sodium.

Contraindications

Hypersensitivity to atropine.

Thyrotoxicosis, tachycardia secondary to cardiac insufficiency.

Cardiospasm         .

Caution in patients with Down’s Syndrome.

Paralytic ileus/Gastrointestinal obstruction.

Pyrexia.

Nursing responsibilities

Monitor vital signs with cardiorespiratory monitor.

Monitor urinary output.

Strict mouth care.