Guidance For:

The use of Vasopressor Agents by

Peripheral Intravenous Infusion in
Adult Critical Care Patients
Version 1.1
 Contents

Guidance For: The use of Vasopressor Agents by Peripheral

Intravenous Infusion in Adult Critical Care Patients

List of Contributors...........................3
Introduction.......................................4
Standards.........................................5
Recommendations............................6
Adrenaline........................................7
Noradrenaline...................................8
Metaraminol......................................9
Phenylephrine.................................10
Background....................................11
References.....................................13

Published date: November 2020

Interim update: September 2022
Review date: November 2023

2 | Guidance For: The use of Vasopressor Agents by Peripheral Intravenous Infusion in Adult Critical Care Patients
 Contributors

List of Contributors
Standards and Guidelines Committee (ICS)

Dr Sam Clark – Trainee in Intensive Care Medicine (Mersey School of Intensive Care Medicine,
Health Education England – North West), Trainee Advisory Group Member (Intensive Care Society)
Mr Greg Barton FRPharmS FFRPS MPhil – Specialist Pharmacist in Critical Care & Burns
(St Helens and Knowsley Teaching Hospitals NHS Trust)
Dr Paul Dean – Chair of Standards and Guidelines Committee (Intensive Care Society), Consultant in
Intensive Care and Anaesthesia (East Lancashire Hospitals NHS Trust)
Dr Yun Mei Lau – Medical Fellow (Intensive Care Society)
Ms Andrea Baldwin – Network Director, Lancs and South Cumbria Critical Care Network and Nursing
Professional Affairs Group (Intensive Care Society)

List of Abbreviations
PVC Peripheral Venous Cannula
CVAD Central Venous Access Device
CVC Central Venous Cannula

Guidance For: The use of Vasopressor Agents by Peripheral Intravenous Infusion in Adult Critical Care Patients | 3
 Introduction

Introduction
This document aims to provide guidance to adult critical care professionals on the administration of
vasopressor agents via a peripheral venous cannula (PVC) to adult critical care patients and to set out
safe principles and standard concentrations in order to inform local policy.
We anticipate that in most circumstances this would be done as a bridging measure as an adjunct to
good patient management, until such a time that a central venous access device (CVAD) is available; or
used for a short term under specific circumstances.
Whereas traditionally it has been commonplace to only administer vasopressor agents via a CVAD (with
the risks of peripheral extravasation often cited as the reason for this), the practice of administering
vasopressor agents peripherally is emerging (as it is in anaesthetic practice in the perioperative period)
with a recent systematic review of over 1300 patients suggesting the risk of doing so being lower than is
anecdotally cited [1]. This review reported that extravasation events were uncommon (event rate 3.4%),
with no reported incidents of tissue necrosis or limb ischaemia.
The most common alternative to a PVC is the insertion of a central venous cannula (CVC) [2] [3]. Whilst the
use of ultrasound-guided insertion will aid in the reduction of the incidence of such risks, many remain
clinically significant (such as pneumothorax, arterial injury, arrhythmias and catheter-related infection)
and so it seems sensible to consider circumstances wherein administration via PVC may be preferable.
Such situations might include, but are not limited to, stabilisation of critically unwell patients awaiting
transfer to a critical care area; short term post-operative use; patient preference; or where central
venous access would prove problematic. The decision will ultimately come down to local policy and the
responsible senior decision-maker at the time.

4 | Guidance For: The use of Vasopressor Agents by Peripheral Intravenous Infusion in Adult Critical Care Patients
 Standards

Standards
1. Critical care units must have clear policies detailing the use of vasopressor agents administered
by peripheral intravenous infusion. These policies must include details on concentration, dose and
infusion of selected vasopressor agents and highlight that these concentrations may differ from the
recommended standard concentrations for administration via a CVAD.
2. Critical care units must provide clear guidelines on the choice of peripheral venous access devices
and their siting for the administration of vasopressor agents by peripheral intravenous infusion.
3. Critical care units must specify a protocol for regular assessment, and documentation of
assessment, of indwelling intravascular catheters using a suitable scoring system.
4. Critical care units must use an infusion pump for the administration of vasopressor agents by
peripheral intravenous infusion.
5. Critical care units must have clear policies for the management of extravasation events relating to
vasopressor agents administered by peripheral intravenous infusion.
6. Vasopressor agents must only be administered by professionals trained in their use and competent
to do so.

Guidance For: The use of Vasopressor Agents by Peripheral Intravenous Infusion in Adult Critical Care Patients | 5
 Recommendations

Recommendations
1. Peripheral venous access should ideally be of size 20G or more; be sited proximal to the wrist in the
arm; avoid sites of flexion in awake patients; avoid sites requiring more than one venepuncture; and
there should be a return of blood following insertion and flush easily with 5-10mL of 0.9% sodium
chloride.
2. A second peripheral venous cannula should be sited as a contingency in case of a primary site
failure.
3. Trusts should use standard concentrations for infusions of peripheral vasopressor agents, and
these should be standardised across all clinical areas. We recommend following the standard
concentrations detailed in the monographs below. Please note that these concentrations may differ
from the recommended standard concentrations for administration via a CVAD.
4. Local policy should detail clinical practitioners who can initiate the use of vasopressor agents by
peripheral intravenous infusion.
5. Local policy should detail in which clinical areas practitioners can initiate and/or maintain the use of
vasopressor agents by peripheral intravenous infusion.
6. Local policy should detail any maximum rate and/or duration of administration of vasopressor agents
by peripheral intravenous infusion.
7. Local policy should detail who, if anyone, may decide to deviate from the local policy.
8. Local policy should detail the required time interval to review the administration of vasopressor
agents by peripheral intravenous infusion.
9. Invasive blood pressure monitoring is recommended but it is acknowledged that it might not be
considered appropriate in all cases. Regular interval non-invasive blood pressure monitoring must
be ensured in these cases.
10. Where an adverse event occurs (for example, extravasation of vasopressor agent), this should be
reported and investigated using the local healthcare organisation’s incident reporting system. All
learning should be widely shared.

6 | Guidance For: The use of Vasopressor Agents by Peripheral Intravenous Infusion in Adult Critical Care Patients
 Adrenaline

Adrenaline

PHarmacological Properties
Adrenaline is a direct-acting sympathomimetic agent with both alpha- and beta-adrenergic activity, the
former being predominant at higher doses. Its effect on blood pressure ceases about 2-3 minutes after
discontinuing the infusion.

Presentation
Adrenaline 1mg/mL (1:1000) solution for injection.

Dilution
For dilution in either 0.9% sodium chloride injection or 5% glucose.

The recommended standard concentration in an adult critical care area for administration via peripheral
venous cannula is 16microgram/mL.

Example dilution: Dilute 4mg Adrenaline (4mL of Adrenaline 1mg/mL) with 246mL 0.9% sodium chloride
to provide a concentration of 16microgram/mL.

Method of Administration & Dose

Administer via an infusion pump at a rate of 210microgram/hour (13mL/hour of the standard
concentration given above, based on a 70kg patient at a starting dose of 0.05microgram/kg/min).
Titrate to desired effect.

Special Considerations
After discontinuation, flush the peripheral cannula with sodium chloride 0.9% at the same rate the
medicine was infused to avoid adverse haemodynamic effects.

The concomitant administration of adrenaline and other medicines via a Y-site should be avoided to
prevent inadvertent bolus administration of adrenaline.

Sources of Information
Electronic Medicines Compendium available at http://www.medicines.org.uk [4]

Medusa Injectable Medicines Guide available at http://medusa.wales.nhs.uk [5]

Medicines Complete available at http://www.medicinescomplete.com [6]

Guidance For: The use of Vasopressor Agents by Peripheral Intravenous Infusion in Adult Critical Care Patients | 7
 Noradrenaline

Noradrenaline

Pharmacological Properties
Noradrenaline is a sympathetic agent with both alpha- and beta-adrenergic activity, the former being
predominant at the concentrations used in clinical practice. Its effect on blood pressure ceases 1-2
minutes after discontinuing the infusion.

Presentation
Noradrenaline 1mg/mL concentrate for solution for infusion.

Dilution
For dilution in either 0.9% sodium chloride injection or 5% glucose.

The recommended standard concentration in an adult critical care area for administration via peripheral
venous cannula is 16microgram/mL.

Example dilution: Dilute 4mg Noradrenaline (4mL of Noradrenaline 1mg/mL) with 246mL 0.9% sodium
chloride to provide a concentration of 16microgram/mL.

Method of Administration & Dose

Administer via an infusion pump at a rate of 210microgram/hour (13mL/hour of the standard
concentration given above, based on a 70kg patient at a starting dose of 0.05microgram/kg/min*).
Titrate to desired effect.

Special Considerations
After discontinuation, flush the peripheral cannula with sodium chloride 0.9% at the same rate the
medicine was infused to avoid adverse haemodynamic effects.

The concomitant administration of noradrenaline and other medicines via a Y-site should be avoided to
prevent inadvertent bolus administration of noradrenaline.

Sources of Information
Electronic Medicines Compendium available at http://www.medicines.org.uk [4]

Medusa Injectable Medicines Guide available at http://medusa.wales.nhs.uk [5]

Medicines Complete available at http://www.medicinescomplete.com [6]

*Starting dose based on CENSER study [7]

8 | Guidance For: The use of Vasopressor Agents by Peripheral Intravenous Infusion in Adult Critical Care Patients
 Metaraminol

Metaraminol

None of the recent observational studies cited above investigated the use of metaraminol as
a vasoactive agent, nor could we find any publications pertaining to it in the context of this
guidance. However, it is commonly used in practice therefore has been included in this guidance.
Recommendations are made from the summary of product characteristics and consensus opinion.

Pharmacological Properties
Metaraminol is a sympathetic agent with direct and indirect effects on adrenergic receptors. It has both
alpha- and beta-adrenergic activity, the former being predominant. The effects of metaraminol are
similar to those of noradrenaline but it is much less potent and has more prolonged action – the effect
of a single dose lasts from about 20 minutes up to one hour (therefore effects taper off when therapy is
stopped). Its onset is around one or two minutes.

Presentation
Metaraminol 10mg/mL Solution for injection or infusion.

Dilution
For dilution in either 0.9% sodium chloride injection or 5% glucose.

The recommended standard concentration in an adult critical care area for administration via peripheral
venous cannula is 0.5mg/mL.

Example dilution: Dilute 20mg Metaraminol (2mL of Metaraminol 10mg/mL) with 38mL 0.9% sodium
chloride to provide a concentration of 0.5mg/mL.

Method of Administration & Dose

Administer via an infusion pump at a rate of 0.5mg to 10mg/hour (1 to 20mL/hour of the standard
concentration given above).

Special Considerations
After discontinuation, flush the peripheral cannula with sodium chloride 0.9% at the same rate the
medicine was infused to avoid adverse haemodynamic effects.

Use in caution in patients on digoxin since the combination can cause ectopic arrhythmic activity.

Sources of Information
Electronic Medicines Compendium available at http://www.medicines.org.uk [4]

Medusa Injectable Medicines Guide available at http://medusa.wales.nhs.uk [5]

Medicines Complete available at http://www.medicinescomplete.com [6]

Guidance For: The use of Vasopressor Agents by Peripheral Intravenous Infusion in Adult Critical Care Patients | 9
 Phenylephrine

Phenylephrine

Pharmacological Properties
Phenylephrine is a sympathomimetic agent with mainly direct effects on adrenergic receptors. It has
predominantly alpha-adrenergic activity. It is effective for up to 20 minutes.

Presentation
Phenylephrine 10mg/mL Solution for injection or infusion.

Dilution
For dilution in either 0.9% sodium chloride injection or 5% glucose.

The recommended standard concentration in an adult critical care area for administration via peripheral
venous cannula is 100microgram/mL.

Example dilution: Dilute 50mg Phenylephrine (5mL of Phenylephrine 10mg/mL) with 495mL 0.9% sodium
chloride to provide a concentration of 100microgram/mL.

Method of Administration & Dose

Administer via an infusion pump at a rate of up to 10.8mg/hour initially (108mL/hour of the standard
concentration given above) reduced according to response to between 1.8-3.6mg/hour (18-36ml/h of the
standard concentration).

Special Considerations
After discontinuation, flush the peripheral cannula with sodium chloride 0.9% at the same rate the
medicine was infused to avoid adverse haemodynamic effects.

Metabolised by monoamine oxidase therefore contraindicated in patients on monoamine oxidase

inhibitors.

Sources of Information
Electronic Medicines Compendium available at http://www.medicines.org.uk [4]

Medusa Injectable Medicines Guide available at http://medusa.wales.nhs.uk [5]

UK Clinical Pharmacy Association Minimum Infusion Volumes For fluid restricted critically ill patients.
4ed. [8]

10 | Guidance For: The use of Vasopressor Agents by Peripheral Intravenous Infusion in Adult Critical Care Patients
 Background

Background

Many publications describing extravasation and local tissue injury resulting from administration of
vasopressor agents via a peripheral or central route pre-date 1969 and such reports may not accurately
reflect current practice [9]. A more recent retrospective case note review in the United States of 202
patients found an extravasation event rate of 4% (2 patients receiving noradrenaline and 2 patients
receiving phenylephrine via a PVC), with all events being of lower severity grading and requiring only
conservative management [10]. This is supported by four other studies (two retrospective case note
reviews and two prospective observational studies) reporting event rates of 2% [11], 3% [12], 5% [13] and
5.5% [14], again without any tissue injury or requiring any surgical intervention. Another retrospective chart
review of 91 patients treated with noradrenaline, with the majority (86.8%) administered via a peripheral
cannula, reported “no signs of ischaemia or necrosis around the area of infusion” in either group [15];
and another more recently reported an exceptionally low event rate of 0.035% (5/14,385 patients) when
administering noradrenaline peripherally in elective peri-operative patients – whilst acknowledging
that this is a different patient population to other studies cited [16]. One study however did report higher
adverse event rates with PVC versus CVC, although on closer inspection the most frequently reported
event was difficulty in inserting the line itself [17].

For comparison we sought complication rates for CVC, however, studies are very much heterogeneous.
Two recent small observational studies found complication rates of between 1.9% (mechanical
complications only) and 5.9% [18] [19]. We consider that these rates are at least comparable, however as
stated previously, complications associated with CVC insertion remain clinically significant, therein lying
the case for the use of PVC outlined in this document.

Choice of size and site of peripheral venous cannula

There is no persuasive evidence to suggest a link between the choice of site for PVC and extravasation
events. Cardenas-Garcia et al 2015 reported the in the majority of cases (75%) vasoactive agents were
administered through a 20G cannula and they reported the lowest event rate of 2% [11]. Other studies
reported variability regarding PVC size and location where extravasation events occurred [10], or had
implemented specific requirements for inclusion
(such as vein diameter measured on ultrasonography, upper extremity only, 18G or 20G cannula size
etc.) [11] [14].

We would suggest that clinicians choose a site in which they are confident and consider the use of
ultrasound in their assessment. Some of the studies that we have cited employed common-sense
guidance on choice of size and site of PVC which we feel would be wise to follow:

• Choose at least a 20G PVC size

• Locate in a site in the arm, proximal to the wrist

• Avoid sites of flexion in awake patients due to the risk of occlusion

• Avoid sites requiring more than 1 venepuncture

• Ensure there is a return of blood following insertion of the PVC and that the PVC flushes easily
with 5-10mL of 0.9% sodium chloride

• Site a second PVC in case of failure of the primary site

Midline catheters may also be considered (peripherally inserted catheters which can be inserted into
larger veins where blood flow is generally faster and duration of use can be up to 28 days) as an
alternative where appropriate training and experience is available [20].

Guidance For: The use of Vasopressor Agents by Peripheral Intravenous Infusion in Adult Critical Care Patients | 11
 Background

Standardising Concentration and Dosage

There is minimal data from the existing evidence to wholly support a single standardised concentration.
However, based on consensus opinion we have provided a recommended standard concentration in
order to reduce the risk of error that might occur should variable concentrations be used. Tables 1 and
2 in the appendix summarise the relevant information from the studies referenced in this document. It
should be noted that these concentrations are reduced as compared to those recommended for
administration via a CVAD and as such are not interchangeable.

Duration of Infusion
There is minimal data existing to wholly support a maximal duration of infusion with regards to safety.
However, from the minimal available data, it may be that infusion via a PVC is safe for a matter of days
though we acknowledge that it would be expected that the risk would increase with duration of infusion.
Therefore, this should be determined locally and be at the discretion of the responsible senior decision-
maker on a case by case basis. Table 3 in the appendix summaries the relevant information from the
studies referenced in this document.

Extravasation
Extravasation describes the inadvertent leakage of any drug or fluid into the surrounding tissues.
Events may occur due to multiple risk factors including those related to the access device, the infusion
or the patient [21]. Regular monitoring of the infusion site is essential to enable early recognition and
management of extravasation events.

There are only case reports to support the management of extravasation. In the studies referenced
in this guideline, there was no documented tissue injury or any need for surgical intervention. Local
guidelines should be followed in the event of extravasation and a conservative strategy as suggested in
Figure 1 may be considered sufficient.

Figure 1. Suggested management of an extravasation event.

1. Stop the infusion immediately and disconnect the line from the PVC.
2. Attempt to aspirate 3-5mL from the PVC if able.
3. Remove the cannula and apply a dressing to the removal site.
4. Mark the extravasation area if possible, in order to allow monitoring of any developing injury.
5. Elevate the affected limb if able to do so to reduce swelling.
6. Consider application of a topical vasoactive agent to encourage local blood flow (for example
nitroglycerin paste).
7. Administer analgesia if required.
8. Seek advice from a surgeon or your local tissue viability service if concerned.
9. Document the incident and report via local incident reporting system.

12 | Guidance For: The use of Vasopressor Agents by Peripheral Intravenous Infusion in Adult Critical Care Patients
 References

References

[1] D. H. Tian, C. Smyth, G. Keijzers, S. P. Macdonald, S. Peake, A. Udy and A. Delaney, “Safety of
peripheral administration of vasopressor medications: A systematic review,” Emergency Medicine
Australasia, vol. 32, no. 2, pp. 220-227, 2020.

[2] S. Hodzic, D. Golic, J. Smajic, S. Sijercic, S. Umihanic and S. Umihanic, “Complications Related to
Insertion and Use of Central Venous Catheters (CVC),” Medical Archives,
vol. 68, no. 5, pp. 300-303, 2014.

[3] The Association of Anaesthetists of Great Britain & Ireland, “Safe vascular access 2016,” The
Association of Anaesthetists of Great Britain & Ireland, London, 2016.

[4] “Electronic Medicines Compendium,” Datapharm Limited, [Online]. Available:

https://www.medicines.org.uk/emc/. [Accessed 16 06 2020].

[5] NHS Injectable Medicines Guide Group (acting through Imperial College Healthcare NHS Trust),
“NHS Injectable Medicines Guide,” 2012. [Online]. Available:
https://medusa.wales.nhs.uk. [Accessed 16 06 2020].

[6] The Royal Pharmaceutical Society, “Medicines Complete,” [Online]. Available:

https://www.medicinescomplete.com/. [Accessed 16 06 2020].

[7] C. Permipikul, S. Tongyoo, T. Viarasilpa, T. Trainarongsakul, T. Chakorn and S. Udompanturak,

“Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER).
A Randomized Trial.,” American Journal of Respiratory and Critical Care Medicine,
vol. 199, no. 9, pp. 1097-1105, 2018.

[8] United Kingdom Clinical Pharmacy Association, Minimum Infusion Volumes for fluid restricted
critically ill patients, 2nd ed., Leicester: United Kingdom Clinical Pharmacy Association, 2012.

[9] O. M. Loubani and R. S. Green, “A systematic review of extravasation and local tissue injury
from administration of vasopressors through peripheral intravenous catheters and central venous
catheters,” Journal of Critical Care, vol. 30, no. 3, pp. 653.e9-e17, 2015.

[10] T. Lewis, C. Merchan, D. Altshuler and J. Papadopoulos, “Safety of the Peripheral Administration of
Vasopressor Agents,” Journal of Intensive Care Medicine, vol. 34,
no. 1, pp. 26-33, 2019.

[11] J. Cardenas-Garcia, K. F. Schaub, Y. G. Belchikov, M. Narasimhan, S. J. Koenig and

P. H. Mayo, “Safety of Peripheral Intravenous Administration of Vasoactive Medication,” Journal of
Hospital Medicine, vol. 01, no. 9, pp. 581-585, 2015.

[12] S. Datar, E. Gutierrez, A. Schertz and V. Vachharajani, “Safety of Phenylephrine Infusion Through
Peripheral Intravenous Catheter in the Neurological Intensive Care Unit,” Journal of Intensive Care
Medicine, vol. 33, no. 10, pp. 589-592, 2017.

[13] T. Delgado, B. Wolfe, G. Davis and S. Ansari, “Safety of peripheral administration of phenylephrine
in a neurologic intensive care unit: A pilot study,” Journal of Critical Care, vol. 34, pp. 107-110,
2016.

[14] K. Medlej, A. A. Kazzi, A. E. H. Chehade, M. S. Eldine, A. Chami, R. Bachir, D. Zebian and G. A.

Dagher, “Complications from administration of vasporessors through peripheral venous catheters:
an observational study,” The Journal of Emergency Medicine, vol. 54, no. 1, pp. 47-53, 2018.

Guidance For: The use of Vasopressor Agents by Peripheral Intravenous Infusion in Adult Critical Care Patients | 13
 References

[15] M. Hallengren, P. Astrand, S. Eksborg, H. Barle and C. Frostell, “Septic shock and the
use of norepinephrine in an intermediate care unit: Mortality and adverse events,” PLOS
ONE, vol. 12, no. 8, p. e0183073, 2017.

[16] C. Pancaro, N. Shah, W. Pasma, L. Saager, R. Cassidy, W. van Klei, F. Kooij, D. Vittali,
M. Hollman, S. Khetepal and P. Lirk, “Risk of Major Complications After Perioperative
Norepinephrine Infusion Through Peripheral Intravenous Lines in a Multicenter Study,”
Anesthesia and Analgesia, vol. 131, no. 4, pp. 1060-1065, 2020.

[17] J. D. Ricard, L. Salomon and A. Boyer, “Central or peripheral catheters for initial venous
access of ICU patients: a randomized controlled trial,” Critical Care Medicine, vol. 41, no.
9, pp. 2108-2115, 2013.

[18] L. Heidemann, N. Niket, R. Sagana, V. Chopra and M. Heung, “A Contemporary

Assessment of Mechanical Complication Rates and Trainee Perceptions of Central
Venous Catheter Insertion,” Journal of Hospital Medicine, vol. 12, no. 8, pp. 646-651,
2017.

[19] J. Bell, M. Goyal, S. Long, A. Kumar, J. Friedrich, J. Garfinkel, S. Chung and S.

Fitzgibbons, “Anatomic Site-Specific Complication Rates for Central Venous Catheter
Insertions,”
Journal of Intensive Care Medicine, vol. 35, no. 9, pp. 869-874, 2020.

[20] C. Hallam, V. Weston, A. Denton, S. Hill, A. Bodenham, H. Dunn and T. Jackson,

“Development of the UK Vessel Health and Preservation (VHP) framework: a multi-
organisational collaborative,” Journal of Infection Prevention, vol. 17, no. 2, pp. 65-72,
2016.

[21] P. M. Reynolds, R. MacLaren, S. W. Mueller, D. N. Fish and T. H. Kiser, “Management

of Extravasation Injuries: A Focused Evaluation of Noncytotoxic Medications,”
Pharmacotherapy, vol. 34, no. 6, pp. 617-632, 2014.

[22] S. Macdonald, G. Keijzers, D. McD Taylor, F. Kinnear, G. Arendts, D. M. Fatovich, R.

Bellomo, D. McCutcheon, J. Fraser, J.-C. Ascencio-Lane, S. Burrows, E. Litton, A.
Harley, M. Anstey and A. Mukherjee, “Restricted fluid resuscitation in suspected sepsis
associated hypotension (REFRESH): a pilot randomised controlled trial,” Intensive Care
Medicine, vol. 44, no. , pp. 2070-2078, 2018.

14 | Guidance For: The use of Vasopressor Agents by Peripheral Intravenous Infusion in Adult Critical Care Patients
 Appendix

Table 1. Drug concentrations reported in publications

Study Noradrenaline Phenylephrine

Concentration range (Dilution) Concentration range (Dilution)
Pancaro et al 2020 [16] 20 microgram/ mL Not studied
Permpikul et al 2019 [7] 16 microgram/ mL Not studied
(4mg in 250mL)
Lewis et al 2019 [10] 16 to 64 microgram/ mL 20 to 400 microgram/mL
Datar et al 2017 [12]
Not studied 120 microgram/mL
Medlej et al 2017 [14]
32 microgram/mL Not studied
(8mg in 250mL)
Delgado et al 2016 [13] Not studied 40 microgram/mL
Cardenas-Garcia et al 2015 [11] 32 to 64 microgram/ mL 160 to 320 microgram/mL
(8 to 16mg in 250mL) (80 – 160mg in 500mL)

Table 2. Drug doses reported in publications

Dose Noradrenaline Phenylephrine

Dose range Dose range
Pancaro et al 2020 [16] 0.01 microgram/kg/min (starting dose) Not studied
0.1 microgram/kg/min (maximum
dose)
Permpikul et al 2019 [7] 0.1 microgram/kg/min (median dose); Not studied
0.05-0.18 microgram/kg/min (IQR)
Lewis et al 2019 [10] 0.08 microgram/kg/min (median 50 microgram/kg/min (initial dose);
dose); 25-95 microgram/kg/min (median
0.04-0.13 microgram/kg/min (median min/max)
min/max dose)
Datar et al 2017 [12] Not studied 1.04 (0.07-3.49) microgram/kg/min
(mean max dose (range))
Medlej et al 2017 [14] 30 microgram/minute (max rate) Not studied
Delgado et al 2016 [13]
Not studied 0.53 (0.19-1.84) microgram/kg/min
(Average dose (range))
Hallengren et al 2016 [15] 0.05 microgram/kg/min (starting Not studied
dose);
0.2 microgram/kg/min (maximum
dose)
Cardenas-Garcia et al 2015 [11] 0.7±0.23 microgram/kg/min (SD) 3.25±1.69 microgram/kg/min (SD)

Table 3. Duration of peripheral vasopressor infusion reported in publications

Study Noradrenaline Phenylephrine
Median (Range), hours Median (Range), hours
Lewis et al 2019 [10] 7.45 (3-23) 15 (6-38)
Datar et al [12]
Not studied Mean 19 (1-129)
Medlej et al 2017 [14]
13 (2-146) Not studied
Delgado et al 2016 [13]
Not studied 14.29 (1-54.3)
Cardenas-Garcia et al 2015 [11] Not provided for individual drugs. Duration quoted as 49±22 hours

Guidance For: The use of Vasopressor Agents by Peripheral Intravenous Infusion in Adult Critical Care Patients | 15
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