Description and indication for use
Noradrenaline is a sympathomimetic agent
that acts on adrenergic receptors. Its main effects include increased vascular
resistance through vasoconstriction, increased heart rate and myocardial
contractility.
The main indications for use would be in
the uncontrolled hypotensive neonate or to redirect blood flow more centrally
in the peripherally vasodilated septic baby.
Discussion with the NETS Consultant is
mandatory if considering using Noradrenaline.
Ensure hypovolaemia is treated prior to commencement of Noradrenaline.
Dose
NB. 1 mg Noradrenaline Acid Tartrate
= 0.5 mg Noradrenaline Base.
Always prescribe doses in terms of base
concentration to avoid confusion and check ampoule label carefully when
administering.
IV:
Initially 0.05 – 0.5 micrograms/kg/min,
titrate as required (usual max 1 – 2 microgram/kg/min). NOTE:
Doses greater than 500 nanogram/kg/min are rare and must be discussed with a consultant.
Always given as a continuous infusion via
central line. Do not infuse through a
peripheral vein due to risk of severe vasoconstrictive complications. When administration is no longer necessary,
gradually wean dose. Do not stop abruptly.
Reconstitution/Dilution
Ampoule:
Ampoule: Noradrenaline Base 2 mg/2 mL (labelled
as Acid Tartrate Salt).
IV Bolus
Not recommended.
IV Infusion
0.05 micrograms/kg/min to a maximum 0.5 micrograms/kg/min.
Add 0.3 mg/kg (300 micrograms/kg) to
infusion solution (Glucose 5% or 10%) to a total volume of 50 mL (as shown in
table below).
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How
to make up
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Dose
equivalent
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Dose
range
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0.3 mg/kg in 50 mL
(300 micrograms/kg in 50 mL)
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1 mL/hr = 0.1 micrograms/kg/min
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0.05 to 0.5 micrograms/kg/min
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Route and method of administration
Not to be given as IV bolus, IM or SC
injection.
Give centrally – never peripherally. Always
given as a continuous infusion.
Side effects
Cardiac arrhythmias, tachycardia, bradycardia.
Anxiety, headache.
Respiratory difficulty.
Extravasation necrosis at injection site.
Anaphylaxis.
Hypertension.
Reduced renal blood flow – renal ischaemia.
Hyperglycaemia.
Contraindications
Untreated hypovolaemic shock.
Peripheral or mesenteric vascular thrombosis.
Existing tachyarrhythmia.
Asymmetric septal hypertrophy.
Sulphite allergy.
Drug interactions
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Monoamine oxidase inhibitors, Tricyclic
antidepressants
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Prolonged hypertension can result.
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Halogenated anaesethetic agents
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Serious cardiac arrhythmias may occur
with concomitant use.
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Digoxin
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Increased risk of arrhythmias.
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Beta blockers
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Risk of hypertension.
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Doxapram
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Risk of hypertension.
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Nursing responsibilities
Administer via central line administration only.
Monitor blood pressure and heart rate.
Monitor peripheral perfusion.
Monitor urine output.
Do not administer bolus doses.
Avoid interruption of infusion.
Change infusion solution every 24 hours.
Protect noradrenaline syringe from light.
Cover syringe with foil.
Compatibility information
Important: Contact pharmacy for drugs not appearing in the table below. Uncommon drugs have been omitted and may be
incompatible.
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Compatible
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Incompatible
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Fluids
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Glucose
5% and 10%, Sodium Chloride 0.9%.
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Alkaline
solutions, TPN.
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Drugs
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Amikacin
Sulphate, Magnesium Sulphate, Meropenem, Ranitidine.
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Aminophylline,
Insulin Neutral, Phenobarbitone Sodium, Phenytoin, Sodium Bicarbonate.
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Y-Site
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Adrenaline,
Amiodarone, Calcium Salts, Dobutamine, Dopamine, Fentanyl Citrate, Frusemide,
Glyceryl Trinitrate, Heparin Sodium, Hydrocortisone Sodium Succinate, Midazolam,
Morphine Sulphate, Potassium Chloride, Vecuronium, Verapamil.
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Notes: Keep ampoules in manufacturers box until time of preparation
Do not subject
ampoules or infusions to heat – decomposition rate increases.
Extravasation
The antidote for extravasation ischaemia is Phentolamine.
To prevent sloughing and necrosis of an area in which extravasation has
occurred, immediately infiltrate 10 – 15 mL saline containing 5 – 10 mg Phentolamine. Infiltrate liberally into the area with a
needle and syringe.