stimulates alpha adrenergic receptors, producing vasoconstriction and decreased heart rate
at low doses, stimulates beta adrenergic receptors to enhance myocardial contractility
2.5 - 5 mcg/min by infusion, targeted to effect
> 5 mcg/min by infusion
dose is titrated to effect
8 mg/250mL dextrose 5%, normal saline 0.9% or Ringer's Lactate
Protect from light
Colour change from clear to brown indicates a loss of potency
Hypovolemia, hypoxemia and acidosis should be corrected concurrently with initiation of therapy
Should be weaned off
inadvertent boluses may precipitate profound hypertension which may result in myocardial infarction, cerebral ischemia
norepinephrine alone, without inotropic therapy may worsen stroke volume in left ventricular dysfunction in patients with poor ejection fraction n by increasing systemic afterload
bradycardia (tachycardia may occur if hypovolemic or if afterload has been increased)
renal ischemia resulting in decreased urine output
increased blood glucose
extravasation of drug may cause tissue necrosis (Rx with 5-15mg phentolamine in NS - see phentolamine monograph)
norepinephrine + anaesthetics = increased risk of cardiac arrhythmias
continous heart rate and rhytym
central or mixed venous oxygen saturation
cardiac index if monitored
SVRI if monitored
changes in skin colour or tempurature
Adult Critical Care Protocol:
May be administered by IV infusion by a nurse in Adult Critical Care.
May be titrated by a nurse in Adult Critical Care.
Must be administered via central venous access device; in emergency situations may be temporarily infused through a peripheral vasuclar access device until a central venous line can be established.
Patient requires placement of an arterial line to monitor BP.
Continuous infusions must be administered by infusion device and the pump library must be enabled.
Should not be infused via the proximal injectate port (blue) of a pulmonary artery catheter. If this is the only available central venous line, it may be administered through the proximal injectate port but thermodilution cardiac output measurements must not be measured during infusion).
Lynne Kelly, Pharmacist, CCTC
Brenda Morgan, Clinical Nurse Specialist, CCTC Last Update: September 17, 2018