PERFUSION OF ICU DRUGS

PERFUSOR
 FUROSEMIDE
 DEFINITION
Furosemide commonly sold under the brand
name Lasix is a loop diuretic which is used
to reduce fluid build-up in the body due to
conditions such as heart failure, liver
scarring or kidney disease.
GENERIC NAME; Furosemide
TRADE NAME; Laxis
PHARMACOLOGICAL CLASS; Diuretic
THERAPEUTIC CLASS; Loop
HOW IT IS SUPPLIED; 10mg/ml supplied in
2ml ampoule single doses container,
 CONT’N
 INDICATIONS
 Hypertensive crises
 Acute pulmonary edema / Generalized edema
 Congestive cardiac failure
 Kidney disorders ( E.g. Nephrotic syndrome,
Acute renal failure)
 Increased intracranial pressure
 Hypermagnesaemia
 Hyperkalaemia
 Also given as a pre-med in blood transfusion
(whole blood) especially in children and geriatrics.
 CONT’N
FORMS
It comes in various forms and the dosage is
based on the medical condition, weight, age
and the response to treatment by the patient.

IV/IM - 10mg/ml OR 20mg/2mls

o Tablets- 20mg/ 40mg/ 80mg

Standard adult dose for perfusing is
250mg/50mls N/saline
 pediatric dose ; 125mg/50mls
 REQUIREMENT

A trolley containing
A perfusor with cable (and connect to power
source to ensure if its working)
Perfusor syringe and perfusor line
Inj Lasix (dosage as prescribed)
Syringe(20cc,10cc) depending on the
dosage to be perfused
Sterile water / normal saline
 Gloves
Needles
 CONT’N

sterile gauze or cotton swabs in a

gallipot
Drip stand
Plaster and marker
Receiver for used swabs
Patient chart
 Methylated spirit
 PROCEDURE
 Identify patient and introduce self to help establish
rapport.
 Check from patient’s chart if drug is prescribed
with right dosage to avoid medication errors.
Explain procedure to patient to gain patient
cooperation.
 Provide privacy and assess the cannulation site
where medication is to be connected (whether to a
central venous line, femoral or peripheral line).
 monitor vital signs and urine output
 Wash hands to reduce risk of infection
 CONT’N
Prepare and set trolley with needed
requirements.
Check if perfusor is working and there
is power source
Fix perfusor to drip stand and connect
to cable
Wash hands to reduce risk of infection.
Crosscheck all items on trolley with
colleague., i.e. expiry dates and if drug
is clear with no sediments.
 CONT’N
 Draw required dosage of drug as prescribed
 Draw required sterile water or normal saline
for mixing
 Mix drug well into perfusor syringe
 Label perfusor syringe, perfusor line and the
perfusor machine with the type of drug
administered and dosage
 Connect perfusor line and expel air into a
receiver
Insert perfusor syringe into pump.
 CONT’N

Set flow rate on pump

Don gloves, clean port and connect line
to patient
Thank patient and document procedure
done
Monitor patient for any adverse
reactions and urine output
 COMPLICATIONS

Hypotension
 Hypokalemia
 Hyperuricemia
 Polyuria
 Glycosuria
 ADRENALINE OR EPINEPHRINE
GENERIC NAME; Adrenaline or Epinephrine
TRADE NAME; Epipen, Twinject, Adrenaclick
PHARMACOLOGICAL CLASS; Strong Alpha and Beta
Adrenergic
THERAPEUTIC CLASS; Vasopressor
HOW IT IS SUPPLIED; 1mg/ml supplied in 1ml
ampoule single doses container, 30ml vial multiple
dose container.

INDICATIONS
Anaphylaxis
Induction and maintenance of mydraisis during
intraocular surgery
Bronchospasm
 ROUTE OF ADMINISTRATION

1. Intramuscular
2. Subcutaneous
3. Intraocular
4. Endotracheal (if IV assess is delayed or
can’t be established)
5. Intravenous (may require central line
infusion)
 DOSAGE
Anaphylaxis (adrenaline available as a 1ml
single use and 30ml multiple -dose vials: inject
adrenaline intramuscularly or subcutaneously
into the anterolateral aspect of the thigh.
Adult or children 30kg or more 0.3mg to 0.5mg
(0.3 to 0.5mls) of undiluted adrenaline
administered IM or subcutaneously in the
anterolateral aspect of the thigh up to
maximum of 0.5mg per injection. Repeat every
5 to 10 minutes as necessary. For IV use dilute
with 1ml of the drug in 10mls of N/S.
 DOSAGE CONT’N

Children less than 30kg: 0.01mg/kg

(0.01ml/kg) of undiluted adrenaline
administered IM or SC at the
anterolateral aspect of the thigh up to
a maximum of 0.3mg (0.3mls).
Repeat every 5 to 10 minutes as
necessary
 SIDE EFFECTS

Cardiovascular: angina, arthymias,

hypertension, pallor, palpitations,
tachyarrhythmia, tachycardia, and
vasoconstrictions.
Respiratory; Respiratory difficulties.
Neurological: dizziness, disorientation,
headache, excitability, impaired memory,
nervousness, panic, sleepiness.
 CONT’N

Psychologically: Anxiety,
apprehensiveness, restlessness
Gastrointestinal: Nausea, vomiting
Endothelial damages when used in
the eye at undiluted concentrations
(1mg/ml)
 CONTRAINDICATION

Patient who are hypersensitive to the drug,

Shock
Organic brain damage
Labour
Cardiac dilatation and coronary insufficiency
 REQUIREMENTS
Trolley with the following:
Perfusor and cable
Perfusor line
Perfusor syringe (50mls, 60mls etc.)
Syringe and needle for mixing drug (e.g.
2ml, 5ml, 10ml, 20ml etc.)
Recommended drug(adrenaline)
Normal saline/ Diluent
Gloves
 CONT’N
3-way tap
Marker/ Plaster
Receiver
Patient chart/ Folder
Methylated spirit and a gallipot
containing sterile gauze
Drip stand
Screen
Power source
 
 ASSESSMENT
ASSESSMENT OF PATIENT
Assess patient’s vital signs as a baseline data
Assess for patency of the intravenous line
ASSESSMENT OF MACHINE
Prior to administration, visibly inspect the
pump and the accessories for damage, missing
parts or contamination and check audible and
visible alarms during self-test.
Ensure the unit is properly positioned and
secured. Do not position pump unit above
patient (thus those not connected to a drip
stand).
Only connect to patient once the syringe has
been inserted correctly and there is proper
 PROCEDURE
Procedure Rationale

1. Identify patient, and To allay anxiety

introduce yourself  
2. Explain procedure to patient, To seek his or her consent and
including education of the drug more information on the drug
importance and side effects so that patient can alert in
case of any reaction
3.Wash hands, Clean trolley Infection prevention purposes
with methylated spirit and to create a sterile field
4. Setup trolley with For easy accessibility
requirements
5. Ensure privacy To respect patient dignity
 CONT’N
6. Wash hands and inform patient  
you are about to start the
procedure
7. Fix the perfusor on the drip stand To ensure its functioning
and check the power and in good working
condition
8. Pick drug and cross check with a To avoid errors
colleague
9. Draw the required normal saline  
with the perfusor syringe

10. Draw the required dosage of To avoid errors

the drug and cross check with a
colleague
 CONT’N
 
11. Draw the plunger of the perfusor
syringe down and add the drug and
mix it
12. Connect the perfusor line and To expel air and avoid air
prime embolism
13. Label the syringe, tip of the For easy identification
perfusor line and the drive head and continuation of
nursing care
14. Fix it the perfusor machine and  
connect to the patient
15. Key in the required flow rate and For right dosage over
the volume into the perfusor and appropriate time
observe side effects
Thank patient, wheel the trolley away,  
and wash hands
 SETTING UP OF MAGNESSIUM
SULPHATE PERFUSOR
Magnesium sulphate is also known as a Epson salt.
It is an organic salt with the formula MgSO4
GENERIC NAME; Magnesium sulphate
TRADE NAME;Epsom salt
PHARMACOLOGICAL CLASS;mineral/ electrolyte
THERAPEUTIC CLASS; Anticonvulsant
HOW IT IS SUPPLIED; 4mg in 10ml or 5mg in 10ml
 INDICATIONS

 Pre-eclampsia or eclampsia.
 Acute Nephritis in children.
 Magnesium deficiency in patients
receiving total parenteral nutrition.
 Uterine tetany.
 CONTRAINDICATIONS

 Impaired renal function

 Heart block or myocardial damage
 Drug interaction ( Eg. Nifedipine)
 REQUIREMENT

A trolley containing;
 Perfusor with cable
 Perfusor syringes
 Perfusor line
 Receiver for expelled drug
 Inj MgSO4 4mg/5mg in 10ml
 Normal saline
 CONT’N

 5 or 10ml syringes
 3 way tap
 Gloves
 Needles
 Patient’s folder
 PROCEDURE

Clean trolley with methylated spirit

Set up trolley with the above requirement
Check if there is power
Fix the perfusor on a drip stand
Fix cable to the perfusor
Check if perfusor is functioning
Cross check drug with other staff for the
rights of drug administration
 CLINICAL MONITORING DURING
ADMINISTRATION OF MgSO4

Vital signs especially respiratory rate is >

16cpm
Urine output is > 25ml/hr
Patellar reflexes are present
 COMPLICATIONS OF
MAGNESSIUM SULPHATE

Respiratory arrest
Respiratory depression
Absent patellar reflexes
Renal failure
Magnesium sulphate toxicity
 SETTING UP MORPHINE
THROUGH PERFUSOR
Morphine is a narcotic pain reliever used to treat
moderate to severe pain
GENERIC NAME; Morphine sulfate or Morphine
hydrochloride
TRADE NAME; Duramorph, Astramorph
PHARMACOLOGICAL CLASS; Opiod/Opiate
Analgesics
THERAPEUTIC CLASS; Narcotic analgesics
HOW IT IS SUPPLIED; 4mg/ml or 10mg/ml,
8mg/ml
 INDICATION
Relief of mderate to severe acute and
chronic pain
Relief of pain in patients who require opiod
analgesics for more than few days
Management of pain not responsive to non-
narcotic analgesics
Pre-operative sedation
Adjunct to anaesthesia
Analgesia during labour
 CONTRAINDICATION

Hypersensitivity to opiates
Upper airway obstruction
Acute bronchial asthma
Diarrhoea caused by poisoning or
toxins
 PHARMACOLOGICAL EFFECT

Morphine acts directly on the central nervous

system(CNS) to decrease the feeling of pain.
It does so by decreasing pain impulse
transmission at the spinal cord level
interacting with opiod receptors to produce
CNS depression .
It also causes respiratory depression ,
peripheral vasodilation, inhibition of intestinal
peristalsis
 ROUTES OF ADMINISTRATION

Intravenous injection
Intramuscular/subcutaneous injection
Intrathecal (spinal)/Epidural injection
Oral (tablet/capsule)
Rectal (suppositories)
AVERAGE DOSAGE FOR MORPHINE PERFUSION
IN ADULT
10MG IN 10ML
20MG IN 20ML
30MG IN 30ML
THERAPEUTIC EFFECT
Decreases pain

ADVERSE REACTION
CARDIOVASCULAR;
Hypotension, palpitation, tachycardia, anxiety,
seizures, shock, fainting, hallucination,
nervousness, cardiac arrest, hypertension
CENTRAL NERVOUS SYSTEM;
Lightheadedness, delirium, euphoria,
drowsiness, dizziness, disorientation, sedation,
headache, restlessness.
 CONT’N
DERMATOLOGIC(SKIN) ;
Profuse sweating(diaphoresis), urticaria,
pruritus.
EENT;
Blurred vision, runny nose, watery eyes,
widened pupil, miosis(contraction of the pupil)
GASTROINTESTINAL;
Constipation, stomach pain or upset, vomiting,
nausea, anorexia, dry mouth
 CONT’N
GENITOURINARY;
Urinary retention, oliguria, decreased libido
RESPIRATORY ;
Bronchospasm, respiratory depression,
breathing difficulty, depression of the cough
reflex, laryngospasm, respiratory arrest,
apnea
OTHERS;
Thrombocytopenia, local irritation, pain at
injection site
 CONT’N

Draw 40-45ml of normal saline

Mix well
Connect the perfusor line and expel air
into the receiver
Label the syringe and tip of the perfusor
line
Fix the perfusor syringe to the perfusor
 PRECAUTIONS BEFORE USAGE

Find out whether patient is allergic to

morphine or medication that contains
codeine
Find out if patient is breastfeeding since it is
excreted in breast milk
Find out if patient is taking drugs like other
pain relievers, antidepressants, cough
medication, sedatives, tranquilizers and
vitamins
Check for particles and discoloration, if any
 CONT’N
If it is given as IM/subcutaneous, it is
important to change the site with each
injection to avoid problems around the skin.
Large muscles such as buttocks or hip
muscle should be used.
Should not stop taking the drugs suddenly,
since it can cause withdrawal symptoms such
as sweating, runny nose.
Should call doctor if severe side effects
occurs.
Nausea can be reduced by administering
 NURSING CONSIDERATION
 Assess pain, location type and character using the
pain scale.
 Use with extreme caution in clients with head injury,
increased intracranial pressure, seizures, chronic
pulmonary disease, severe hepatic or renal disease,
prostatic hyperplasia, acute abdominal conditions,
elderly.
 When giving IV by direct injection 2.5 to 15mg may
be diluted in 4 to 5ml of sterile water and given over
4 to 5 minutes.
 Know that morphine is the drug of choice in relieving
pain in myocardial infarction. May cause transient
decrease in blood pressure
 CONT’N
 Morphine may worsen or mask gallbladder pain.
 Monitor circulatory, respiratory, bladder and bowel
function carefully, since drug may cause respiratory
depression, hypotension and urine retention, nausea,
vomiting or altered level of consciousness regardless
of the routes used. Withhold dose and notify doctor if
respirations are below 12 bpm.
 Constipation is more often severe with maintenance
dosage. Ensure that stool softener or other laxative is
ordered.
 Morphine appears in breast milk. Breast feeding
women should wait 2 to 3 hours after last dose before
 SIGNS OF OVERDOSE
Clammy skin
Pinpoint pupil
Nausea and vomiting
Severe constipation
Lowered blood pressure
Irregular heart beat
Bluish discoloration of the lips, skin and
fingernails
Dizziness and drowsiness
Weak and thready pulse
 CONT’N
Headache
Gastrointestinal spasm
Difficulty urinating
Anxiety
Fluid in the lungs
Seizure and tremors
Muscle flaccidity
Shallow, difficult breathing
Memory loss
 MANAGEMENT OF OVERDOSE
The goal of treatment possible irreversible damage
caused by overdose. Treatment for morphine
overdose is mainly supportive of the symptoms
manifested by patient. The following can be done;
Intravenous fluid administration
Application of activated charcoal via nasogastric
tube for toxin absorption
Within 2 hours of ingestion, perform gastric lavage or
empty the stomach by inducing vomiting(ipecac
syrup)
Administration of laxative to counteract constipation
 CONT’N

Administration of narcotic
antagonist- naloxone (0.2mg-0.8mg ,
IV, an antidote to morphine and its
side effects
Monitoring of vital signs
Respiratory support
Oxygen therapy
vasopressors
REQUIREMENT FOR SETTING UP IV
MORPHINE USING THE PERFUSOR
A perfusor with cable (and connect to power source
to ensure if its working)
Perfusor syringe and perfusor line
Inj Morphine (dosage as prescribed)
Syringe(20cc,10cc) depending on the dosage to be
perfused
Sterile water / normal saline
 Gloves
Needles
 CONT’N
sterile gauze or cotton swabs in a gallipot
Drip stand
Plaster and marker
Receiver for used swabs
Patient chart
 Methylated spirit
 3-way tap
 PROCEDURE
 Identify patient; for self introduction and assess
patient
 Explain procedure to patient
 Provide privacy
 Wash hands
 A peripheral or central access line should be
established prior to setting up infusion
 Clean trolley with methylated spirit. For infection
prevention
 Setup trolley with requirements
 Seek patient’s consent to allay any anxiety
 CONT’N
Connect perfusor cable to perfusor and power
source
Boot the perfusor and check for functioning
Prepare drug and mix with the desired normal
saline in the perfusing syringe and observe the
rights of drug administration
Connect the perfusor line to the perfusor
syringe and prime into a receiver to expel the air
and avoid air embolism
Label the perfusor syringe and tip of the
perfusor line with a plaster and marker, for easy
 CONT’N
Fix perfusor syringe to the perfusor and set
rate of flow of the drug to be perfused for right
dosage
Record baseline vital signs and start perfusing
drug
Record time, drug rate and vital signs on
patient’s chart.
Observe patient for any reaction
Document procedure and thank patient
Discard used items and disinfect trolley and
wash hands
 NITROGLYCERIN OR GLYCERYL
TRINITRATE(GTN)

GENERIC NAME: NITROGLYCERIN OR Glyceryl

Trinitrate
TRADE NAMES :
Nitrocerin , Nitrocin , Nitrocontin, Anginil , Angised ,
Corodil , Glynit , GTN spray , Leonite etc
PHARMACOLOGICAL CLASS :Nitrates
THERAPEUTIC CLASS : Vasodilating agent
HOW IT IS SUPPLIED: 1 ml/1 mg
 CONT'N

1ml of solution contains 1mg of Glyceryl Trinitrate .

It comes in : 5ml/5mg ampoule, 10ml/10mg ampoule,

25ml.25mg ampoule and 50ml/50mg vial.

Pharmaceutical form:
The product is a clear and colourless solution.
 THERAPEUTIC INDICATIONS

• Unresponsive congestive heart failure, including

that secondary to acute myocardial infarction; acute
left-sided heart failure and acute myocardial
infarction.
• Refractory unstable angina pectoris and coronary
insufficiency, including Prinzmetal's angina.
• Control of hypertensive episodes and/or myocardial
ischaemia during and after cardiac surgery.
 CONT'N

• Induction of controlled hypotension for surgery.

MECHANISM OF ACTION
Glyceryl Trinitrate is a vasodilating agent. Its
principle pharmacological action is the relaxation of
vascular smooth muscle. Glycerol Trinitrate
produces, in a dose related manner, dilation of both
arterial and venous beds.
 MECHANISM OF ACTION CONT'N

Dilation of the post capillary beds, including large

veins, promotes peripheral pooling of blood and
decreases venous return to the heart reducing left
ventricular and end diastolic pressure (pre-load).
Arteriolar relaxation reduces systemic vascular
resistance (after-load). Myocardial oxygen
consumption is decreased by both the arterial and
venous effects of Gylceryl Trinitrate.
 MECHANISM OF ACTION CONT'N

Theraputic doses of this drug will reduce systolic,

diastolic and mean arterial pressure. Effective
coronary perfusion is usually maintained but may be
compromised if blood pressure falls excessively or
increased heart rate decreases diastolic filling

ROUTES OF ADMINISTRATION
Sublingual, transdermal, by mouth, intravenous
 METHOD OF ADMINISTRATION
Trinitrate can be administered undiluted by slow
intravenous infusion using a syringe pump
incorporating a glass or rigid plastic syringe.
Alternatively, Glyceryl Trinitrate may be administered
intravenously as an admixture using a suitable vehicle
such as Sodium Chloride Injection B.P. or Dextrose
Injection B.P. In case of dilution, Glyceryl Trinitrate
must be mixed under aseptic conditions immediately
after opening.
 METHOD OF ADMINISTRATION
CONT'N

Prepared admixtures should be given by intravenous

infusion or with the aid of a syringe pump to ensure a
constant rate of infusion.
During Glyceryl Trinitrate administration there should
be close haemodynamic monitoring of the patient.
 CONTRAINDICATIONS

Glyceryl Trinitrate should not be used in the following

cases:
• Hypersensitivity to the active substance, other nitrates
• Acute circulatory failure (shock, collapse)
• Cardiogenic shock (unless a sufficient end-diastolic
pressure is maintained by appropriate measures)
• Severe anaemia,
• Severe cerebral haemorrhage
 CONTRAINDICATIONS CONT'N

• Head trauma
• Uncorrected hypovolaemia and hypotensive shock
• Arterial hypoxaemia and angina caused by hypertrophic
obstructive cardiomyopathy
• Constrictive pericarditis
• Pericardial tamponade
• Toxic pulmonary oedema.
 SPECIAL WARNINGS AND
PRECAUTIONS

Caution should be exercised in patients with severe liver

or renal disease, hypothermia, hypothyroidism.
Glyceryl Trinitrate should not be given by bolus injection.
Glyceryl Trinitrate must be used only with particular
caution and under medical supervision in:
• Low filling pressures e.g. in acute myocardial infarction,
impaired left ventricular function (left ventricular failure).
Reducing systolic blood-pressure below 90 mmHg must
 SYMPTOMS OF OVERDOSE

Fall in blood pressure ≤ 90 mmHg

• Pallor
• Sweating
• Weak pulse
• Reflex tachycardia
• Collapse
• Dizziness postural
• Diarrhoea
 TREATMENT OF OVERDOSE

Stop delivery of the drug.

- Patient should be kept horizontal with the head
lowered and legs raised or, if necessary, compression
bandaging of the patient's legs
- Supply oxygen
- Expand plasma volume
- For specific shock treatment admit patient to intensive
care unit
 INTERACTIONS WITH OTHER
DRUGS

The blood pressure lowering effect of Glyceryl

Trinitrate will be increased if used together with
phosphodiesterase inhibitors (e.g. sildenafil, vardenafil,
tadalafil) which are used for erectile dysfunction This
might lead to life threatening cardiovascular
complications. Patients who are on nitrate therapy
must not use phosphodiesterase inhibitors (e.g.
sildenafil, vardenafil, tadalafil
REQUIREMENTS

A trolley containing
A perfusor with cable (and connect to power
source to ensure if its working)
Perfusor syringe and perfusor line
Inj GTN (dosage as prescribed)
Syringe(50c,etc) depending on the dosage to
be perfused
Sterile water / normal saline
 Gloves
Needles
 CONT'N
sterile gauze or cotton swabs in a
gallipot
Drip stand
Plaster and marker
Receiver for used swabs
Patient chart
 Methylated spirit
 PROCEDURE
 Identify patient and introduce self to help establish
rapport.
 Check from patient’s chart if drug is prescribed
with right dosage to avoid medication errors.
Explain procedure to patient to gain patient
cooperation.
 Provide privacy and assess the cannulation site
where medication is to be connected (whether to a
central venous line, femoral or peripheral line).
 monitor vital signs and urine output
 Wash hands to reduce risk of infection
 CONT'N

Prepare and set trolley with needed

requirements.
 Check if perfusor is working and
there is power source
 Fix perfusor to drip stand and
connect to cable .
 Crosscheck all items on trolley
with colleague., i.e. expiry dates
and if drug is clear with no
sediments.
 CONT'N
 Draw required dosage of drug as prescribed
 Draw required sterile water or normal saline
for mixing
 Mix drug well into perfusor syringe
 Label perfusor syringe, perfusor line and the
perfusor machine with the type of drug
administered and dosage
 Connect perfusor line and expel air into a
receiver
Insert perfusor syringe into pump.
 CONT'N

Set flow rate on pump

Don gloves, clean port and connect line
to patient
Thank patient and document procedure
done
Monitor patient for any adverse
reactions and urine output
 SIDE EFFECTS

 Tachycardia
 bradycardia
 hypotension
 methaemaglobinaemia; muscle twitching
 drecreased PaO2.
 NOREPINEPHRINE /
NORADRENALINE
GENERIC NAME:Norepinephrine or Noradrenaline
TRADE NAME:evarterenol, Levophed, Norepin, others..
PHARMACOLOGICAL CLASS : Strong Alpha and Beta
Adrenergic
THERAPEUTIC CLASS: Vasopressor
PHARMACEUTICAL FORM:
Solution for infusion
The product is a clear and colourless solution.
 HOW IT IS SUPPLIED

Noradrenaline (Norepinephrine) 1 mg/ml

Concentrate for Solution for Infusion

1 ml concentrate for solution for infusion contains 1

mg noradrenaline base.
1 ampoule of 2 ml contains 2 mg noradrenaline base.
1 ampoule of 4 ml contains 4 mg noradrenaline base.
When diluted as recommended, each ml contains 40
micrograms noradrenaline base.
 THERAPEUTIC INDICATIONS

Indicated for use as an emergency measure in the

restoration of blood pressure in cases of acute
hypotension.

Norepinephrine is used mainly as a

sympathomimetic drug to treat people in
vasodilatory shock states such as septic shock and
neurogenic shock, while showing fewer adverse
side-effects compared to dopamine treatment
 MECHANISM OF ACTION
It stimulates α1 and α2 adrenergic receptors to cause
blood vessel contraction, thus increases peripheral
vascular resistance and results in increased blood
pressure. This effect also reduces the blood supply to
gastrointestinal tract and kidneys. Norepinephrine acts
on beta-1 adrenergic receptors, causing increase in
heart rate and cardiac output.
However, the elevation in heart rate is only transient,
as baroreceptor response to the rise in blood pressure
as well as enhanced vagal tone ultimately result in a
sustained decrease in heart rate.Norepinephrine acts
more on alpha receptors than the beta receptors.
 ROUTE OF ADMINISTRATION
Route of Administration:
For intravenous use

METHOD OF ADMINISTRATION
Administer as a diluted solution via a central
venous catheter.
The infusion should be at a controlled rate using
either a syringe pump or an infusion pump or a
drip counter.
 METHOD OF ADMINISTRATION
CONT'N
Dilution instructions:
Dilute before use with glucose 5% solution or
sodium chloride 9 mg/ml (0.9%) with glucose 5 %
solution.
Either add 2 ml concentrate to 48 ml glucose 5%
solution (or sodium chloride 9 mg/ml (0.9%) with
glucose 5% solution) for administration by syringe
pump, or add 20 ml of concentrate to 480 ml
glucose 5 % solution (or sodium chloride 9 mg/ml
(0.9%) with glucose 5% solution) for administration
by drip counter.
 CONTRAINDICATION AND
SPECIAL WARNING/PRECAUTION

Contraindications
Hypersensitivity to noradrenaline

Special warnings and precautions for use :

 Noradrenaline should only be administered by
healthcare professionals who are familiar with its
use.
 Elderly patients may be especially sensitive to the
effects of noradrenaline.
 SPECIAL WARNING/PRECAUTION
CONT'N

 Particular caution should be observed in patients

with coronary, mesenteric or peripheral vascular
thrombosis because noradrenaline may increase the
ischemia and extend the area of infarction.

 Similar caution should be observed in patients with

hypotension following myocardial infarction, in
patients with Prinzmetal's variant angina and in
patients with diabetes, hypertension or
hyperthyroidism
 SPECIAL WARNING/PRECAUTION
CONT'N

 Noradrenaline should be used with caution in

patients who exhibit profound hypoxia or
hypercarbia.
 Noradrenaline should be used only in conjunction
with appropriate blood volume replacement. When
infusing noradrenaline, the blood pressure and rate
of flow should be checked frequently to avoid
hypertension.
 Extravasation of the solution may cause local tissue
necrosis. The infusion site should be checked
frequently. If extravasation occurs, the infusion
should be stopped and the area should be infiltrated
with phentolamine without delay.
 SPECIAL PRECAUTION/WARNING
CONT'N
 Prolonged administration of any potent vasopressor
may result in plasma volume depletion which
should be continuously corrected by appropriate
fluid and electrolyte replacement therapy. If plasma
volumes are not corrected, hypotension may recur
when the infusion is discontinued, or blood pressure
may be maintained at the risk of severe peripheral
and visceral vasoconstriction (e.g., decreased renal
perfusion) with diminution in blood flow and tissue
perfusion with subsequent tissue hypoxia and lactic
acidosis and possible ischaemic injury.

 Contains sodium. To be taken into consideration by

patients on a controlled sodium diet,
 INTERACTIONS WITH OTHER
DRUGS
 Its use with volatile halogenated anaesthetic agents,
monoamine oxidase inhibitors, linezolid, tricyclic
antidepressants, adrenergic-serotoninergic drugs or
any other cardiac sensitising agents is not
recommended because severe, prolonged
hypertension and possible arrhythmias may result.
 Noradrenaline may impair placental perfusion and
induce fetal bradycardia. It may also exert a
contractile effect on the pregnant uterus and lead to
fetal asphyxia in late pregnancy. These possible
risks to the fetus should therefore be weighed
against the potential benefit to the mother.
 SIDE EFFECTS
Psychiatric disorders:
Anxiety
Nervous system disorders:
Headache
Cardiac disorders:
Arrhythmias (when used in conjunction with cardiac
sensitising agents), bradycardia, stress cardiomyopathy
Vascular disorders:
Hypertension, peripheral ischaemia including gangrene
of the extremities, plasma volume depletion with
prolonged use
Respiratory : dyspnea
General disorders and administration site conditions
Extravasation necrosis at injection site
 OVERDOSE

Overdosage may result in severe hypertension, reflex

bradycardia, marked increase in peripheral resistance
and decreased cardiac output. These may be
accompanied by violent headache, photophobia,
retrosternal pain, pallor, intense sweating and vomiting.
In the event of overdosage, treatment should be
withdrawn and appropriate corrective treatment
initiated.
REQUIREMENTS
Trolley with the following:
Perfusor and cable
Perfusor line
Perfusor syringe (50mls, 60mls etc.)
Syringe and needle for mixing drug (e.g.
2ml, 5ml, 10ml, 20ml etc.)
Recommended drug(noradrenaline)
Normal saline/ Diluent
Gloves
 CONT'N

3-way tap
Marker/ Plaster
Receiver
Patient chart/ Folder
Methylated spirit and a gallipot
containing sterile gauze
Drip stand
Screen
Power source
 
 PROCEDURE
 Identify patient and introduce self to help establish
rapport.
 Check from patient’s chart if drug is prescribed
with right dosage to avoid medication errors.
Explain procedure to patient to gain patient
cooperation.
 Provide privacy and assess the cannulation site
where medication is to be connected (whether to a
central venous line or femoral ).
 monitor vital signs and urine output
 Wash hands to reduce risk of infection
 CONT'N
Connect perfusor cable to perfusor and power
source
Boot the perfusor and check for functioning
Prepare drug and mix with the desired normal
saline in the perfusing syringe and observe the
rights of drug administration
Connect the perfusor line to the perfusor
syringe and prime into a receiver to expel the air
and avoid air embolism
Label the perfusor syringe and tip of the
perfusor line with a plaster and marker, for easy
identification
 CONT'N
Fix perfusor syringe to the perfusor and set
rate of flow of the drug to be perfused for right
dosage
Record baseline vital signs and start perfusing
drug
Record time, drug rate and vital signs on
patient’s chart.
Observe patient for any reaction
Document procedure and thank patient
Discard used items and disinfect trolley and
wash hands
That was the last slide

Thank you