When newborns are in distress, it’s often due to ineffective respirations and slow heart rate. Timely positive pressure ventilation using a flow-inflating bag and facemask or flow-inflating bag and endotracheal tube will usually resolve these problems.
Sometimes the heart rate remains extremely low, below 60 beats per minute, despite positive pressure ventilation and chest compressions for 30–60 seconds. When this happens, it’s often necessary to draw up and give epinephrine intravenously or through the endotracheal tube. The intravenous route is preferred, but in either case, the epinephrine must be drawn up correctly and quickly.
Be sure to use the neonatal epinephrine formulation of 1:10,000 found in a brown box. This must not be confused with the adult epinephrine formulation of 1:1000 found in a glass vial and readily available if anesthesia is being used on the baby’s mother.
Use the following steps when drawing up 1:10,000 epinephrine:
- Prior to delivery, discuss the appropriate dose with the medication nurse.
Use the most accurate estimate of fetal weight possible. Epinephrine dosing based on 0.2 ml/kg will likely fall within the proper intravenous dosing range of 0.1–0.3 ml/kg. Read the potential dose of epinephrine to the medication nurse, and have them read it back to you. This helps to eliminate dosing errors caused by calculations done in a rush.
- After opening the epinephrine box, screw the needle into the 10 ml ampule of 1:10,000 epinephrine.
- Take a 1 ml syringe and pull the plunger to 1 ml, filling it with 1 ml of air.
- Inject the epinephrine into the 1 ml syringe, tapping out any air bubbles and pushing the extra epinephrine out of the syringe until you have the desired dose.
Your epinephrine dose is now ready to be given intravenously through an umbilical venous catheter, peripheral IV, or through an intraosseous needle.
Following these steps will allow you to effectively draw up the correct dose of 1:10,000 epinephrine for a baby who hasn’t responded to your positive pressure ventilation and chest compressions.