Practical considerations in the administration of intravenous vasoactive drugs in the critical care setting: the double pumping or piggyback technique-part one.

Part I of this review aims to identify the factors associated with safe administration of continuous intravenous vasoactive drug therapy, specifically epinephrine and norepinephrine. Intravenous vasoactive drugs are administered in the critical care setting to maintain patients' cardiovascular function by continuous intravenous infusion. To ensure uninterrupted administration, one infusion is commenced when the other is almost empty. A technique often employed to achieve this is known as 'double pumping' or 'piggybacking'. Due to the absence of a standardised protocol for administering continuous intravenous vasoactive medication and technological developments in infusion pumps, a review of current literature was undertaken. Despite a paucity of evidence regarding safe administration of these drugs, recommendations from the available literature included ensuring that critical care nurses are competent and formally trained in the use of equipment and the administration of continuous intravenous vasoactive medication. Furthermore, the infusion pump should feature minimal start up delay, a sensitive occlusion alarm system and the absence of a bolus in the event of infusion occlusion. This may reduce patients experiencing adverse haemodynamic responses due to alterations to the infusion. Indeed, a review of the 'double pumping' or 'piggybacking' technique in the clinical setting is required to establish current practice and develop evidence based guidelines.