Noradrenaline Administration Protocol

Hi!

Are you a nurse already? Are you in the US? Are you working in a hospital? Do they have a specific policy for the administration of drugs? Are you in a critical care area or emergency?

I am after information on the administration and safety strategies in place for noradrenaline. As far as I am aware, noradrenaline must be administered to a central line (which in my state the giving set is bright orange coloured) with a three-way tap and must not be flushed with NS after use. So how do you check IV line patency if you can not flush the line?

I understand the logistics of not flushing a noradrenaline line as doing so can cause a bolus of medication to the patient which can be life-threatening. Is there any literature on the flushing of noradrenaline lines? Or incidences of medication errors involving noradrenaline?

At nursing school, we are taught to flush before and after giving an IV medication as a given. However, this is not the case with noradrenaline? Should I also not flush IV lines for other high-risk medications e.g. insulin infusions?

Thanks in advance.

The care of these lines are dictated by hospital policy. The infusion of these medicines are also dictated by policy. As a general rule you do not "flush" these lines and are usually infused in a dedicated port where nothing else is infused to there would be no reason to flush for patency.

http://med.umkc.edu/docs/em/IV_Med_Reference.pdf

https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0010/306397/liverpoolNoradrenaline.pdf

Hi Esme12,

I am a nursing student and thus do not have access to the hospital policies unless I am on placement. I am in Australia and focusing on the ICU setting.

I am trying to find literature on this "general rule" that you do not flush a noradrenaline line. I do not feel there is enough safety measures and education about "accidental drug boluses". I have noticed elsewhere in the world, there are "do not bolus" IV line labels.

We had an incident of an accidental noradrenaline bolus.

I can not find much information about aspirating blood back from the IV line and reasons why we do this. If we are to finish a noradrenaline treatment (no more infusions), as we can't "flush" the line with NS we would aspirate blood back? This would allow us to check for patency and remove any blood clots? I have seen nurses do this as they have said they don't want to push meds through if they do not know what was in that line before.

Thanks for your comments thus far.

In the US I have not seen "Do not bolus" labels. We do label lines with what they are infusing at the injection port to try to prevent accidental bolus. In the US when a drug is weaned A new bag and tubing are hung and replace the infusion at the same low rate (remember you have weaned the drug) and the infusion infuses at the last rate the Levophed was infusing.

It is not necessary to check the patency of a central line during infusions. Here in the US we document at what point the line is secured and if that stays consistent you do not have to check for placement. Central lines are sutured into place. If there was an infusion infusing there is no danger of clotting (there is always a danger of clots with any invasive line but you do not have to routinely flush to prevent them.

Not flushing/infusing into lines with vasoactive drips is one of those "known" facts that critical care nurses know. I am not sure what you are getting at.

Again...I would not be familiar with what is done in the UK. That link you provided is very detailed I would think it would be a good reference for you. I am sure the DO NOT FLUSH was an initiative that was instituted after a serious drug error occurred.

What we do here in the US isn't going to be useful for you for your project. Are you a student?

Here we would wean the drug then (if fluid is not a problem) hang a plain IV at the last rate. If necessary and fluid needs to be stopped....yes we would remove (aspirate) 10mls of blood then flush according to hospital Policy and procedure.

Here in the US critical care nurses are specially trained for these area. Our hospitals formulate their own policies for care of vasoactive and other titrated drips.

A few pieces of information provided are incorrect.A central line,any type can have a secondary malposition and is not as uncommon as you would think. One I see a lot of is a flip up into the ipsilateral Internal Jugular.At least that type is a vein and not extravascular!A blood return on a CVAD is a great sign that it is in a vessel but not a guarantee it is in proper position thus the necessity of a chest radiograph or the use of a tip verification system and frequent assessment for signs and symptoms of malposition.If you are infusing the Levophed and you are not meeting any resistance and not having any downstream occlusions then you just keep infusing and do not let bags run dry.

In my second post I mentioned the necessity of a CXR

Where I have worked we call it Norepinephrine or levophed. It is also, usually, administered via a central line...which would be a triple lumen/multilumen, Swan Ganz/pulmonary artery catheter. These lines are verified position by chest x ray and blood return.

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