Titration of noradrenaline via central line for septic shock and other vasoplegic shock states.
Indications
- • Septic shock with MAP < 65 despite fluids
- • Vasoplegia
Contraindications
- ⚠ Uncorrected hypovolemia (fluids first)
Equipment
- • Central venous access
- • Infusion pump
- • Norepinephrine 4 mg in 250 mL D5W (16 µg/mL)
Positioning
- • As appropriate for the procedure and patient comfort.
Consent
- • Explain indication, benefits, alternatives
- • Explain risks & complications
- • Obtain written/verbal consent as per SOP
- • Document consent
Universal precautions
- • Hand hygiene
- • PPE — gloves, mask, eye protection
- • Aseptic technique
- • Sharps safety
- • Verify patient identity & site
Step-by-step (0/6)
Tap to complete
Peripheral only if short-term & large vein.
Immediate complications
- ⚠ Extravasation → necrosis
- ⚠ Arrhythmia
- ⚠ Reflex bradycardia
Delayed complications
- • Digital ischemia
Recognition
- • Site pallor
- • Rhythm change
Initial management
- • Stop; phentolamine SC for extravasation
Prevention
- • Central access
- • Frequent monitoring
Post-procedure observation
- • Vitals q15min × 1h then hourly
Monitoring
- • Site inspection
- • Symptom review
Documentation
- • Procedure note
- • Consent
- • Findings
Patient instructions
- • Report pain, bleeding, fever, worsening symptoms
Related in WardRound
Educational bedside guide. Perform only under supervision until competent. Follow local SOPs and consent policy.
