The following is a summary of “Preparation/administration of push-dose versus continuous infusion epinephrine and phenylephrine: A simulation,” published in the December 2023  issue of Emergency Medicine by Morley, et al.

Hypotension is common in the emergency room (ED) and intensive care unit (ICU), and it can make it more likely that bad things will happen. Many emergency rooms and intensive care units (ICUs) use epinephrine and phenylephrine to treat low blood pressure. These drugs are usually given as a continuous infusion (CI). Push-dose (PD) gives small amounts of medicine through periodic intravenous pushes (IVPs). There isn’t a lot of data that compares the time needed to prepare and give PD vs. CI, and mistakes have been made when these drugs are prepared and given at the bedside. For a simulation study, researchers sought to find out how long it takes to prepare and give PD and CI epinephrine and phenylephrine, as well as how many mistakes are made when prepared by an ED/ICU pharmacist.

The study used a multi-venous intravenous training arm kit with an 18-gauge intravenous line, an extension tube set, and a luer-lock adapter. It took place in a simulation center at a university medical center. Total planning and management time in seconds was the main result. The second result was big mistakes in preparation and administration, which were described as mistakes that led to an overdose of five times or more. 16 pharmacists took part, with 9 from the emergency room and 7 from the intensive care unit. Aside from preparation time, PD had faster total preparation and administration time and administration time, but not preparation time. PD had a total drop of about 70 seconds in preparation and administration time compared to CI. PD had more major mistakes in preparation and administration. Six of the 32 PD plans (18.8%) had at least one major mistake in preparation and administration. Conversely, CI did not make any big mistakes in planning or running the event.

This test showed that PD epinephrine and phenylephrine took less time to prepare and give than CI epinephrine and phenylephrine. However, it also showed that PD had more major mistakes during preparation and giving. 83.3% (5/6) of their overdoses were caused by mistakes in diluting the medicine when it was being made. The computer study found that ED/ICU pharmacists could prepare and give PD epinephrine and phenylephrine faster than CI pharmacists. However, PD pharmacists make more mistakes when preparing and giving PD medications.

Source: sciencedirect.com/science/article/abs/pii/S0735675723005417