UNCONTROLLED WHEN PRINTED
Introduction
  • Endogenous catecholamine that predominantly stimulates α1 receptors to cause peripheral vasoconstriction and increase blood pressure.
  • It also has some β1 receptor agonist activity that results in a positive inotropic effect on the heart at higher doses.
  • IV/IO: Onset 30 seconds
  • Duration: 5-10 mins
  • Half-life: 2 minutes
Indications
  • Hypotension refractory to adequate fluid resuscitation
  • Primarily distributive shock such as septic shock, neurogenic shock, drug-induced
Contraindications
  • No absolute contraindications
  • Caution in concurrent MAOI therapy and in hypovolaemic shock
Precautions / Notes
  • Hypertension
  • Reflex bradycardia
  • Hyperglycaemia
  • Peripheral ischaemia
  • Extravasation necrosis
Management
IV infusion in adults only
Dilution
  • Dilute 4mg in 4mL with 46mL of 5% Dextrose to produce 4mg in 50mL (80 mcg/mL)
MUST BE LABELLED
  • Administer via a syringe driver
  • Commence infusion at 5mcg/minute (3.75ml/hour) and increase or decrease by 1-2 mcg/minute every 3-5 minutes as determined by MAP.
  • Should be run through a dedicated line
Syringe Driver Noradrenaline 4mg in 50ml (80µg/ml)
Dose range Rate of infusion
1µg/min0.75mL/min
5µg/min3.75mL/min
10µg/min7.5mL/min
20µg/min15mL/min
Monitoring
  • Regular NIBP monitoring (every 3-5 minutes if no invasive monitoring)
  • Continuous ECG monitoring
  • Monitor peripheral vein infusion hourly for blanching or extravasation
Special Considerations
  • Noradrenaline is preferentially administered via a CVC. However, it is acceptable to administer peripherally through a large vein in upper limb (not hand or wrist and preferably not ACF) with an ≥18 gauge cannula
  • Aspirate blood prior to use checking site hourly and monitoring for signs of extravasation
  • Noradrenaline should always been run through a syringe driver or infusion pump and should never be given as a bolus
  • Peripheral noradrenaline should not be run for greater than 6 hours

References

Loubani OM, Green RS. A systematic review of extravasation and local tissue injury from administration of vasopressors through peripheral intravenous catheters and central venous catheters. Journal of critical care. 2015;30(3):653 e9-17.

Safety of peripheral intravenous administration of vasoactive medication. J Hosp Med. 2015 Sep ;10(9):581-5.



References
References
Presentation

4mg in 4mL vial

Dilution
  • Dilute 4mg in 4mL with 46mL of 5% Dextrose to produce 4mg in 50mL (80 mcg/mL)
MUST BE LABELLED
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