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Hemodynamics Management

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Peripheral Administration of Norepinephrine

This prospective observational cohort study conducted in the medical ICU of a quaternary care academic center evaluated the safety and effectiveness of a protocol for peripheral norepinephrine administration, aiming to reduce central venous catheter (CVC) use. Including adult patients from February 2019 to June 2021, findings revealed a median reduction of 1 CVC day per patient, with 51.6% avoiding CVC insertion altogether. Despite 75.8 extravasation events per 1,000 days of peripheral intravenous catheter (PIVC) infusion, most cases resulted in minimal or no tissue injury, and no surgical interventions were required. These results suggest that peripheral administration of norepinephrine can be a safe, viable alternative to traditional CVC use, potentially minimizing associated risks and complications in the ICU setting, and highlight the need for further multicenter studies to validate these findings.

Please note that the protocol of the study dictates that If the maximum allowable dose (15 μg/min) or duration (48 h initially; no time limitation after protocol amendments) of peripheral norepinephrine administration was reached, it was mandatory for providers to place a CVC for continued norepinephrine administration.

What the maximum duration of norepinephrine use through peripheral line in your hospital?

  • 24 hours

  • 48 hours

  • No limit

Ibrahim Ameen
Iyad Demashki


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