Appendix 2 ( continues on page 47 )
Editorial note : the patient names used in Appendix 2 are examples only , and not those of real patients . The guidelines in Appendix 2 are used by the author ' s practice ; other practices may have their own guidelines .
Dexmedetomidine CRI guidelines
Courtesy of Faye Newton , RVN , BSc ( Hons ), VTS ( Anaesthesia ).
It is important that the guidelines are followed exactly , due to the number of errors arising from incorrect dilutions and accidental patient bolus administration .
Figure 1 . An example of correct syringe labelling .
Dexmedetomidine weight category
• Dexmedetomidine 10 µ g / ml : cats and dogs < 15 kg
• Dexmedetomidine 25 µ g / ml : dogs > 15 kg
Diluting dexmedetomidine
It is vital that 50 µ g / ml solutions are no longer made . From now on dexmedetomidine will be diluted to either 10 µ g / ml or 25 µ g / ml using the following dilutions :
• 10 µ g / ml 0.2 ml of neat dexmedetomidine to 9.8 ml of saline
• 25 µ g / ml 0.5 ml of neat dexmedetomidine to 9.5 ml of saline
These solutions can be doubled / halved to make more or less , dependent on the rate . For example , 1 ml of neat dexmedetomidine to 19 ml of saline , or 0.25 ml of neat dexmedetomidine to 4.75 ml of saline , will create a 25 µ g / ml solution .
Labelling the syringe
Syringes must be labelled , every time , with the correct drug labels and filled in as shown in Figures 1 and 2 .
Labelling the line
The syringe driver extension line must be labelled with the smaller , coloured labels at least three times along its length :
• just after the syringe driver
• about halfway along the line
• at the Y-connector .
Any additional extension lines should also be clearly labelled at the connection point .
Figure 2 . An example of correct syringe labelling .
Selecting the correct setting on the syringe driver
Dexmedetomidine is now under two different categories on the syringe drivers , and their dilutions are fixed .
Select the correct category for the dilution that has been made , either Dexmed10 for 10 µ g / ml or Dexmed25 for 25 µ g / ml .
The drug information will be displayed , a reminder of the weight limit and the correct dilution .
Enter the patient ' s weight . Select the rate : ranges from 0.5 to 2.5 µ g / kg / hour .
The correct set-up at the patient
Any patient on a dexmedetomidine constant-rate infusion ( CRI ) must have a Y-connector placed on its IV catheter .
The patient must be placed on IV fluid therapy . These patients are being sedated , so will have minimal , if any , oral intake of fluids . Dexmedetomidine also increases urine output , further increasing losses for the patient .
46 Veterinary Nursing Journal