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/min | 0.75mL/min |
| 5µg/min | 3.75mL/min |
| 10µg/min | 7.5mL/min |
| 20µg/min | 15mL/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 |
| Colour assist: |
|---|
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