|Dr Carl Kuschel,
Brenda Hughes, Mandy Hodgson, Rob Ticehurst (Pharmacy)
Micrograms changed to nanograms June 2002
Instructions regarding CVL December 2002
Management of Noradrenaline Administration
- Clear colourless solution containing noradrenaline base 1 mg/ml (=1000 micrograms/ml) (contains sodium metabisulphite as an antioxidant).
- Stable in solutions of pH 3.6 – 6.0 4.
Charted on fluid chart giving:
- rate in ml/hour
- dose in nanograms/kg/minute
Also charted on drug chart under continuous infusions giving:
- amount of drug to be added
- base fluid type and volume
- Administered by a nurse with Neonatal IV Drug Certification.
- Administered through a Pall 0.2 micron filter into a central venous catheter, except in exceptional
circumstances where a large vein can be used e.g. antecubital or femoral vein, in
preference to veins of the legs 4.
- Dilute 300 micrograms/kg (0.3ml/kg) noradrenaline to 50 ml with glucose 5% (6 micrograms/kg/ml).
Administration in saline solutions alone is not recommended; however glucose 5%
in saline can be used 2
An infusion rate of 0.5 ml/hour = 0.05 micrograms/kg/minute. Dilution can be
varied depending on clinical fluid requirements.
- Do NOT mix with any other drug, IV solution, blood or blood products. Use a separate line for noradrenaline.
- Administer via a syringe pump.
- Change fluid and tubing every 12 hours. Do not use if solution forms a precipitate or if brown
- Give through a central venous line (UVC, Longline, or Surgical CVL).
Observation and Documentation
- Monitor infusion rate frequently.
- Monitor for adverse reactions.
- Observe solution for brown discolouration or precipitate.
- Observe closely for extravasation. Discontinue immediately and notify doctor. Noradrenaline must be immediately
resited as there is a danger of rebound hypotension.
- Continuous blood pressure monitoring.
- Continuous cardio-respiratory monitoring.
- Document vital signs hourly and PRN.
- Never cease infusions abruptly, because of the danger of rebound hypotension.
- At room temperature 15-25°C.
McEvoy GK (ed) AHFS Drug Information 93, American Society of Hospital
Pharmacists, Bethesda, 1993; 745-748.
Data sheet. Levophed; November 1999. Sterling Winthrop.
Reynolds JEF (ed.) Martindale: The Extra Pharmacopoeia. (31st
ed). London : Royal Pharmaceutical Society, 1996.
Royal College of Paediatrics and Child Health. Medicines for Children.
London: RCPCH Publications Ltd, 1999.