Changeover of vasopressors in the intensive care unit

Abstract

Despite being performed several times a day and often in the most critical patients, changeover of catecholamines is not subject to any recommendation of practice. Only few clinical studies are available in the literature. Frequent changes in catecholamine infusion rates are time consuming for nurses and often result in hemodynamic instability. Several techniques for changeover exist, often within the same ICU. Analysis of the literature does not provide enough reasons to prefer one technique over the other. However, teams should be careful with the false impression of security afforded by “smart pumps”. Importantly, it should be clearly stated that efforts should be focused on the rationalization and simplification of the circuits and lines rather than searching for the best changeover technique. Sensitization to and training on the basics of hydraulics and fluid mechanics is essential for medical and nursing staff. Adequate medical devices with the smallest residual volumes, as well as the use of antireflux valves, and the most distal venous access so as to minimize contacts between the different drugs and avoid the propulsion of one drug by another should be recommended.