Description

• Clear solution 500 micrograms/mL (in dehydrated alcohol) in 1mL ampoules.
• Osmolality at 2 micrograms/mL approx. 340mOsm/kg; and at 20 micrograms/mL 925mOsm/kg.⁴
• maximum stability for postaglandin at pH = 3

Prescription

Charted on fluid chart giving:

• rate in ml/hour
• dose in nanograms/kg/minute

Also charted on drug chart under continuous infusions giving:

• amount of drug to be added
• base fluid, type and volume
• concentration in micrograms/mL

Administration

Continuous Infusion

1. To prepare a solution of 125 micrograms/ml:
   1. Add 125 micrograms (0.25ml) of Prostaglandin E1 to 0.75ml 0.9% NaCl
   2. Calculate charted dose of Prostaglandin E1 and make up to 50 ml with 0.9% NaCl, Dextrose 5%, or Dextrose 10%.
2. Y-site compatible with caffeine citrate, dopamine, heparin, and morphine.  Do NOT mix with blood or blood product. Recommended to use a separate line for alprostadil (Prostaglandin E₁) administration. Do NOT flush line.
3. Administered by a nurse with Neonatal IV Drug Certification or infant cardiac unit experience.
4. Dilute as prescribed to 3 - 6micrograms/ml. Maximum concentration = 20micrograms/ml. Mix well.
5. Filter prior to administration through a 5 micron filter needle. Do NOT use a PALL 0.2 micron filter as the air filter may be destroyed by the alcohol content. ⁵
6. Administer into a large vein.
7. Must be given by continuous IV infusion via a syringe pump because of the rapid metabolism of this drug.
8. Compatible with Normal Saline, Dextrose 5%, Dextrose 10%.
9. Maintain a patent IV line at all times.
10. Change solution and tubing every 24 hours.

Observation and Documentation

1. Monitor for adverse reactions, especially decreased respiratory effort, periodic breathing or apnoea.
2. Ensure reliable I.V. access, observe closely for IV infiltration and resite immediately if this occurs.
3. Closely monitor heart rate, respirations, and temperature. Document hourly. 10 –12 % of babies will have apnoea.
4. Assess the duct for patency
5. Monitor oxygenation with blood gases and pulse oximetry.
6. Assess for signs of improvement eg. increased blood oxygenation with cyanotic heart disease; and improved blood pressure, blood pH, and urine output for acyanotic heart disease.
7. Neonates receiving more than 120 hours of PGE1 should be monitored for evidence of antral hyperplasia and gastric outlet obstruction.
    

Storage

• Store in refrigerator at 2°-8°C.
• Discard ampoule after use.
• Diluted solution stable for 24 hours at room temperature.

Selected References