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The administration of dilute solutions of noradrenaline via peripheral venous catheters (PVCs) has gained increasing acceptance in recent years. Large studies have provided reassuring safety data,1 and guidelines recognise this therapy as a short-term measure for blood pressure support,2 particularly in septic shock.3 Despite this the UK critical care community has been slow to accept peripheral noradrenaline; fear of extravasation injury persists in some quarters, and at a recent Investigators’ Meeting of the Early Vasopressors in Sepsis (EVIS) trial this was identified as a significant barrier to recruitment.4
Our Scottish District General Hospital ED introduced a peripheral noradrenaline protocol in 2019 in cooperation with our critical care team, using a concentration of 16 μg/mL.2 Local critical care practice with centrally administered vasopressors is to start infusions at standardised rates independent of patient weight, so the same approach was taken with peripheral noradrenaline. We use infusion rates of 0–13.3 μg/min (0–50 mL/hour) titrated to frequent or continuous blood pressure measurement. Rates may be increased as high as 26.6 μg/min (100 mL/hour) as a bridge to central venous catheter (CVC), or in frailer patients for whom insertion of a CVC is considered too invasive by the treating clinical team. Infusion site …
Footnotes
Handling editor Liza Keating
Contributorship Statement The project was conceived by RR. Data were acquired, cross-checked and analysed by RR, JJ, HR, UO and HM. Interpretation of data was discussed among RR, JJ, HR, UO and HM. The manuscript was drafted by RR and reviewed by all authors prior to submission.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Ethics Statement This project was registered and approved by the NHS Fife Clinical Effectiveness Team, Information Governance Team and Caldicott Guardian (ID number: 23993) as a Service Evaluation not requiring patient consent.
Provenance and peer review Not commissioned; externally peer reviewed.
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