Norepinephrine - PowerPoint Presentation

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Uploaded On 2022-08-03

Norepinephrine - PPT Presentation

Levophed Reason for Protocol change Norepinephrine has replaced Dopamine in our protocols because Dopamine is associated with a greater number of adverse events to include arrhythmias ID: 934645

min drops page mcg drops min mcg page norepinephrine heart orders standing sec rate infusion shock physician cardiac min30

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Slide1

Norepinephrine

(Levophed)

Slide2

Reason for Protocol change

Norepinephrine has replaced Dopamine in our protocols because Dopamine is associated with a greater number of adverse events to include arrhythmia’s

Slide3

Class/Description/ Mechanism of action

ClassSympathomimetic, vasopressor, adrenergic agonist, inotropic

Description Norepinephrine is a naturally occurring potent vasoconstrictor and inotropic agentMechanism of ActionNorepinephrine treats severe hypotension. It increases peripheral vascular resistance, blood pressure, and to a lesser effect heart rate. It may increase myocardial oxygen demand, mandating cautious use in patients with ischemic heart disease. It is relatively contraindicated in patients with hypovolemia. Onset 1-3 minutes, duration 5-10 minutes

Slide4

Indications/contraindications/precautions

IndicationsHypotension due to any shock state (following appropriate fluid resuscitation)

ContraindicationsHypovolemia, profound hypoxia, mesenteric or peripheral vascular disease (ischemia)PrecautionsStart IV in antecubital fossa to lower risk of infiltration. When administering, continually check IV site for patency and signs/symptoms of infiltration. Continually monitor blood pressure. Do not mix with Sodium Bicarbonate, flush tubing well between drugs, or use Y site secondary tubing for norepinephrine running into free flowing normal saline primary tubing.

Slide5

Side Effects/Interactions/dose/Route

Side EffectsTissue necrosis with infiltration, hypertension, headache, anxiety, dysrhythmia, tachycardia, reflex bradycardia, chest pain, increased oxygen demand, nausea/vomiting

InteractionsShould not be administered in the same line as alkaline agents, such as Sodium Bicarbonate. Alkaline solutions may inactivate norepinephrine

Dose/Route

2mcg/min titrated to 20 mcg/min, if needed after fluid bolus is complete to maintain MAP>65 or SBP >100

Slide6

Comparison of Norepinephrine with Dopamine

NorepinephrineIncreases MAP primarily through vasoconstrictionHas little effect on heart rate, stroke volume, and cardiac output

Reason it’s being used as the first line vasopressor DopamineIncreases MAP primarily through an increase in cardiac outputIncreases heart rate and stroke volume

Which could cause potentially harmful tachyarrhythmia's

Slide7

Protocols that contain the use of Norepinephrine

1-4 Cardiac Arrest ROSC- Standing orders for CC’s and Paramedics- page 142-6 Allergic Reaction and Anaphylaxis- Standing orders for CC’s and Paramedics- page 29

2-9 Symptomatic Bradycardia/Heart Blocks- Paramedic standing orders- page 332-12 Cardiogenic Shock- Paramedic standing orders- page 382-41Suspected Septic Shock- Physician option only- page 742-42 General Shock/Hypoperfusion

- Standing orders for CC’s and Paramedics- page 76

2-49 Trauma Hypoperfusion/Hypovolemia- Physician option only- page 862-52 Ventricular Assist Device- Physician option only- page 95

Slide8

Medication Infusions

Norepinephrine infusion chart on page 114 in your collaborative protocols4mg/4mL mixed in Normal Saline 1000 mL = 4mcg/mLChart includes infusion rates and administration sets

Slide9

Infusion Chart

Infusion Rate

Admin Set: 10 drops/mL

Admin Set: 15 drops/mL

Admin Set:

60 drops/mL

2 mcg/min5 drops/min7drops/min30 drops/min

4 mcg/min10 drops/min15 drops/min

60 drops/min or 1 drop/sec

6 mcg/min15 drops/min22 drops/min

90 drops/min or 1.5 drops/sec8 mcg/min