UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE
TITLE: Racepinephrine (Racemic epinephrine)
High Alert Medication
Effective Date: 10/23/2009 Approval: See Authorization
Supersedes Protocol: None Contact: Clinical Staff Education
PURPOSE: To provide guidelines for safe administration of Racepinephrine (Racemic epinephrine) at UWMF Clinics.
DEFINITION: Bronchodilator used in the treatment of bronchospasms, bronchial asthma, viral croup, anaphylactic reactions, and
other lung diseases.
**Racemic epinephrine should only be used in emergent situations and the adult/child will be transported to emergency room
for further observation.
**Contraindications for use: if patient is taking a MAOI, tri cyclic antidepressants, or beta blocker medication
** Caution in use in persons with known history of cardiac disease, hypertension, hyperthyroidism, diabetes mellitus, glaucoma, or
benign prostate hypertrophy
POLICY: The clinical staff (R.N, LPN, or CMA/MA) will utilize the following guidelines to administer Racemic epinephrine and
monitor and document patient status, prior, during and post administration.
SUPPLIES: Racemic epinephrine Inhalation Solution USP 2.25% (0.5ml), 3ml normal saline for dilution, nebulizer unit and
supplies, gloves, stethoscope, blood pressure cuff, pulse oximetry, patient’s medical record, sterile normal saline
1. Check provider’s order and clarify any inconsistencies.
2. Wash hands and gather equipment.
3. Introduce yourself and identify the patient asking for their complete name and date of birth. If patient is a child, you may ask the
parent or guardian for this information.
4. A complete set of vital signs should be taken and documented prior to administration; including pulse oximetry.
5. Explain procedure to the patient, and make the patient comfortable.
6. Racemic epinephrine 2.25% solution must be diluted for use in the nebulizer.
a. Mix 0.5 ml Racemic epinephrine vial with 3ml sterile normal saline.
Do not use this product if it is brown in color or cloudy.
Do not use this product if it is pinkish or darker than slightly yellow, or if it contains a precipitate.
a. Administer over ~15 minutes.
7. Monitor patient:
Continuous monitoring of respiratory rate, pulse rate, and pulse ox during the medication administration.
Monitor patient for any of the following; ask patient to notify you of any of these symptoms:
o Bluish coloration of skin, flushing or redness of face or skin (continuing)
o Dizziness (severe) or feeling faint
o Increased wheezing or difficulty breathing
o Skin rash, hives or itching
o Swelling of face, lips or eyelids
o Chest discomfort (rare)
o Irregular heartbeat (rare)
o Numbness in hands or feet (rare)
o Unusual bruising (rare)
o Hallucinations (documented in cases where high doses used)
8. A complete set of vital signs should be taken and documented after administration; including pulse oximetry.
9. Transport patient via ambulance.
a. Provide visit documentation and patient demographics to ambulance crew.
b. Notify hospital of incoming patient.
Vital signs, including oxygen saturation
Medication(s) utilizing .medinclinic in HealthLink progress note area
How the patient tolerated the procedure
Effects of the medication on patient
Follow-up care or appointment (if needed)
WRITTEN BY: LaVay Morrison, RN, BSN, Clinical Staff Education
REVIEWED BY: Deb Craig, RN, Manager of Urgent Care
Rebecca Harrison, RN, Team Leader, Urgent Care
REFERENCES: HealthFacts for You Adrenergic Bronchodilator (inhalation), 2005
Epocrates Rx Online- UWMF UConnect
Medical Director of Urgent Care Date
Medical Director Date