We currently have an Epi/Cal drip in our formulary (epinephrine 4mg + CaCl 1gm / 250mL D5W). Our maximum rate is 20mL/hr (~5.333mcg/min of epinephrine). Our plain epinephrine drips (various concentrations) have a max rate of 50 mcg/min.
#1: If you currently use EPI/CAL, what evidence/references do you use to support its continued use? -1990's article in Circulation showed that "calcium blunts epinephrine's beta-adrenergic actions in postoperative cardiac surgery patients." We would like to use this article as a foundation for having EPI/CAL removed from formulary.
#2: Those facilities that use EPI/CAL, what maximum rate do you allow? What reference do you use to support this rate?
#3: For those facilities that no longer allow EPI/CAL, what was your strategy to successfully removing from formulary? Our Cardiac Surgeons and Interventional Cardiologists will likely be very reluctant.
Thanks in advance.