IV Medications /vasoactives: Hypovolemia should be corrected before the
administration of any vasoactive agents
● Vasopressors
○ They mimic the effects of the sympathetic nervous system by stimulating
alpha, beta, and other vascular receptors.
○ Half life= 1-2 mins & reach peak effect within 10 minutes
● Dopamine
○ INCREASE in: (low dose) renal blood flow, urine output, (median dose)
HR, Contractility, CO, (high dose) vasoconstriction
○ ONLY give through a central line
○ Side effects: tachycardia, chest pain, nausea, vomiting, arrhythmia
● Epinephrine
○ Low dose: INCREASE in HR, contractility, bronchodilation
○ High dose: Vasoconstrict, decrease renal blood flow, decrease urine
output, increase in glucose
■ Useful when patient in in a low cardiac output state and second
choice for septic shock
■ CENTRAL LINE ONLY
■ Side effects: increase in lactic acid, tremors, palpitations,
arrhythmia, hyperglycemia
● Norepinephrine
○ POTENT vasoconstrictor that will also increase HR and stroke volume =
greater cardiac output.
○ Side effects: Bradycardia, arrhythmia, digital ischemia
■ CENTRAL LINE ONLY
■ Drug of choice for septic shock
● Phenylephrine
○ Extreme peripheral vasoconstriction
○ Side effects bradycardia, arrhythmia, increase urine output
○ Monitor BP, EKG, renal function, and electrolytes
■ USED for patients with hypotension and profound tachycardia
■ CENTRAL LINE ONLY
● Vasopressin
○ ALWAYS a second line agent
○ Constricts vascular smooth muscle
○ Increases responsiveness of vasculature to the catecholamines
○ Replacing a deficiency--this is not a titratable “pressor”
IV Fluids:
● Hypotonic
, ● Isotonic
● Hypertonic
● Colloid
● Crystalloid Solutions
Chest Tubes:
● Drainage of 200 mL/hr or more is usually a bleeding complication
● A rise in water level=increased negative pressure can cause tissue or lung
damage
● Bubbles initially are okay, but if there are bubbles later their may be a leak or the
lung may be collapsed again.
● Tidaling= the water should rise and fall with inhalation and exhalation.
● Monitor and listen to breath sounds
Arterial Lines / Central Catheters
● Arterial Line
○ A peripheral IV in the arterial system used for frequent blood pressure
monitoring when a pt requires vasoactive meds and frequent blood
sampling
○ NOT for administration of fluids or meds
○ Potential complications: ischemia, thrombosis, infiltration, exsanguination
● Central Catheter
○ Used for a number of different reasons:
■ Failure to obtain or maintain peripheral access
■ Complication of peripheral access
■ Pt requires numerous access sites, parenteral nutrition, or
hypertonic fluid administration
■ Treatment failure with IV fluids necessitates readings of central
venous pressure
■ Pt requires vasoactive meds that place the limb at risk if infiltration
occurs
Hypovolemia
● At risk:
○ Eldery (poor oral intake/potential difficult access to water)
○ Abnormal fluid losses, such as those resulting from vomiting, diarrhea, GI
suctioning (nasogastric or intestinal tubes, drains [biliary, pancreatic]),
fever, and sweating
administration of any vasoactive agents
● Vasopressors
○ They mimic the effects of the sympathetic nervous system by stimulating
alpha, beta, and other vascular receptors.
○ Half life= 1-2 mins & reach peak effect within 10 minutes
● Dopamine
○ INCREASE in: (low dose) renal blood flow, urine output, (median dose)
HR, Contractility, CO, (high dose) vasoconstriction
○ ONLY give through a central line
○ Side effects: tachycardia, chest pain, nausea, vomiting, arrhythmia
● Epinephrine
○ Low dose: INCREASE in HR, contractility, bronchodilation
○ High dose: Vasoconstrict, decrease renal blood flow, decrease urine
output, increase in glucose
■ Useful when patient in in a low cardiac output state and second
choice for septic shock
■ CENTRAL LINE ONLY
■ Side effects: increase in lactic acid, tremors, palpitations,
arrhythmia, hyperglycemia
● Norepinephrine
○ POTENT vasoconstrictor that will also increase HR and stroke volume =
greater cardiac output.
○ Side effects: Bradycardia, arrhythmia, digital ischemia
■ CENTRAL LINE ONLY
■ Drug of choice for septic shock
● Phenylephrine
○ Extreme peripheral vasoconstriction
○ Side effects bradycardia, arrhythmia, increase urine output
○ Monitor BP, EKG, renal function, and electrolytes
■ USED for patients with hypotension and profound tachycardia
■ CENTRAL LINE ONLY
● Vasopressin
○ ALWAYS a second line agent
○ Constricts vascular smooth muscle
○ Increases responsiveness of vasculature to the catecholamines
○ Replacing a deficiency--this is not a titratable “pressor”
IV Fluids:
● Hypotonic
, ● Isotonic
● Hypertonic
● Colloid
● Crystalloid Solutions
Chest Tubes:
● Drainage of 200 mL/hr or more is usually a bleeding complication
● A rise in water level=increased negative pressure can cause tissue or lung
damage
● Bubbles initially are okay, but if there are bubbles later their may be a leak or the
lung may be collapsed again.
● Tidaling= the water should rise and fall with inhalation and exhalation.
● Monitor and listen to breath sounds
Arterial Lines / Central Catheters
● Arterial Line
○ A peripheral IV in the arterial system used for frequent blood pressure
monitoring when a pt requires vasoactive meds and frequent blood
sampling
○ NOT for administration of fluids or meds
○ Potential complications: ischemia, thrombosis, infiltration, exsanguination
● Central Catheter
○ Used for a number of different reasons:
■ Failure to obtain or maintain peripheral access
■ Complication of peripheral access
■ Pt requires numerous access sites, parenteral nutrition, or
hypertonic fluid administration
■ Treatment failure with IV fluids necessitates readings of central
venous pressure
■ Pt requires vasoactive meds that place the limb at risk if infiltration
occurs
Hypovolemia
● At risk:
○ Eldery (poor oral intake/potential difficult access to water)
○ Abnormal fluid losses, such as those resulting from vomiting, diarrhea, GI
suctioning (nasogastric or intestinal tubes, drains [biliary, pancreatic]),
fever, and sweating
