In this episode, I’ll discuss an article about low-concentration peripheral norepinephrine infusion.
Peripheral vasopressor administration is generally considered desirable by clinicians in 2 scenarios:
1. A patient’s blood pressure is severely low and waiting for a central line to be placed could cause organ damage due to low perfusion.
2. The clinician suspects the need for vasopressors will be very brief and is hoping to avoid placing a central line only to have its use discontinued in a few hours.
While norepinephrine is often the vasopressor of choice, data on the safe concentration for peripheral administration is scant.
Researchers in Melbourne, Australia recently published a feasibility study of using norepinephrine at a low concentration (10 mcg/mL) via peripheral infusion to prevent hypotension during the intra- and postoperative period in patients undergoing major noncardiac surgery.
60 patients were split between a saline placebo group and norepinephrine infusion titrated to maintain a systolic blood pressure within 10% of their baseline value. Administration lasted through surgery and for up to 24 hours postop.
The authors found that the norepinephrine infusion was likely to achieve the minimum systolic blood pressure threshold. Most importantly, there were no important study drug-related side effects detected in the study. This led them to conclude low concentration norepinephrine infusions are feasible and that a future trial with a larger number of patients should be conducted.
This trial of perioperative patients does not represent the type of hospital inpatient who might need vasopressors for sepsis. However this type of practice setting is where all of the available data for using IV bolus dosing of vasopressors comes from, and since that has been extrapolated to practice in non-perioperative settings, there is a chance that clinicians will want to extrapolate this feasibility study of peripheral norepinephrine at a concentration of 10 mcg/mL into similar practice environments.
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Hi Pharmacy Joe:
I do not think this article can be extrapolated to sepsis shock situations because:
– For septic shock patients, they usually have peripheral ischemia so the possibility to worsen this ischemia is high with infusing Vassopressors peripherally.
– For perioperative Patients: usually they have adequate peripheral blood supply and they do not go to that extent where every non-essential organ shutdown to preserve the essential organs as the case in septic shock.
-In real world septic patient are discovered later may be after 1 to 2 hrs , so we do not know the extent of peripheral ischemia.
But in operative setting the BP is monitored minute by minute and intervention is done immediately so peripheral ischemia is not expected to be immediately associated with drop in BP.
-In real practice I have seen the Infusion of vasopressors through large peripheral vain like the fumeral vain until they insert a central line , usually they don’t exceed 6 hrs in infusing vassopressors peripherally.
Thank you