Abstract
Background and aims: Variations in inotrope changeover technique can contribute to deviations in blood pressure, heart rate, internal bleeding and in extremis, death (Sheppard, 2001; Crisp, 2002; Morrice et al, 2004; Trim and Roe, 2004). Clinical audit was performed to establish inotrope changeover practices in paediatric intensive care (PIC) and highlight inconsistencies amongst the local nursing population.
Methods: Nursing staff (n=80) completed a one sided, questionairre comprising of 5 criteria.
Results: Frequency of inotrope changeover: Nursing staff (n=45) reported implementing inotrope changeover at least once a week. Others perform inotrope changeover every shift (n=25) or even once a fortnight (n=9). Few staff never implement inotrope changeover (n=1).
Side affects observed by staff: Nurses reported witnessing hypertension (n=55) and hypotension (n=49) during inotrope changeover. Tachycardia (n=23) and bradycardia (n=8) were also reported. One respondent reported observing cardiac arrest.
Inotrope changeover practices of staff: Inotrope changeover technique is dependent upon patient stability. The double pumping technique (n=47) was performed frequently. Definitions of double pumping were not examined. Quick change (n=23) and purging (n=32) technique are also used.
Content of nursing documentation: Common themes for nursing documation include current inotrope dose (n=60), adverse events encountered during changeover (n=56), indications for inotrope infusion (n=23), changeover method used (n=16 and reasons for inotrope changeover technique used (n=4).
Conclusions: Inotrope changeover comprises variables not examined here such as job role, experience and patient dependency. Clinical audit has raised awareness of this important issue and the need for more in depth examination of practice.
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Smith, M. 607 Inotrope Changeover in Paediatric Intensive Care. Pediatr Res 68 (Suppl 1), 311 (2010). https://doi.org/10.1203/00006450-201011001-00607
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DOI: https://doi.org/10.1203/00006450-201011001-00607