NORADRENALINE

Levophed

Dr Carl Kuschel, Brenda Hughes, Mandy Hodgson, Rob Ticehurst (Pharmacy)
April 2000
Micrograms changed to nanograms June 2002
Instructions regarding CVL December 2002
Dose and Pharmacology Newborn Drug Protocol Index Newborn Services Home Page

 

Management of  Noradrenaline Administration

Description

Prescription

Charted on fluid chart giving:

Also charted on drug chart under continuous infusions giving:

Administration

Continuous Infusion:

  1. Administered by a nurse with Neonatal IV Drug Certification.
  2. 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.
  3. 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.
  4. Do NOT mix with any other drug, IV solution, blood or blood products. Use a separate line for noradrenaline.
  5. Administer via a syringe pump.
  6. Change fluid and tubing every 12 hours. Do not use if solution forms a precipitate or if brown discolouration observed.
  7. Give through a central venous line (UVC, Longline, or Surgical CVL).

Observation and Documentation

  1. Monitor infusion rate frequently.
  2. Monitor for adverse reactions.
  3. Observe solution for brown discolouration or precipitate.
  4. Observe closely for extravasation. Discontinue immediately and notify doctor. Noradrenaline must be immediately resited as there is a danger of rebound hypotension.
  5. Continuous blood pressure monitoring.
  6. Continuous cardio-respiratory monitoring.
  7. Document vital signs hourly and PRN.
  8. Never cease infusions abruptly, because of the danger of rebound hypotension.

Storage

Selected References

1 McEvoy GK (ed) AHFS Drug Information 93, American Society of Hospital Pharmacists, Bethesda, 1993; 745-748.
2 Data sheet. Levophed; November 1999. Sterling Winthrop.
3 Reynolds JEF (ed.) Martindale: The Extra Pharmacopoeia. (31st ed). London : Royal Pharmaceutical Society, 1996.
4 Royal College of Paediatrics and Child Health. Medicines for Children. London: RCPCH Publications Ltd, 1999.