Inotropes and peripheral lines
I’d be interested to hear of other people’s experience on this subject. Do people run inotropes like noradrenaline (norepinephrine) through peripheral lines at all?
Best practice suggests use of a central line to avoid peripheral ischaemia, though I’m aware of several situations recently where peripheral lines were used for inotropes – one argument I’ve seen is that a large bore IV in the cubital fossa region is sufficient (for at least short term) in emergency patients waiting transfer to ICU.
Another situation where I’ve seen it used recently (also cubital fossa) is post arrest.
I haven’t personally been involved in any extravasation issues with inotropes, however I have seen this happen with other infusions (like an IV that tissued at CT, the whole contrast scan 150mls was thrown into the tissues of the arm – not so good!). I can image that inotrope leakage into the tissues would not go over too well..
ok this is a little late, but i figured it wouldn’t hurt to reply. normally you don’t want to use a peripheral line, but you have to use what you must if the patient is crashing and dont have anything else available to you- normally you try to get at larger bore line in the anticube to run it through that if at least possible. i’ve seen lines infiltrate before with norepinephrine and you are supposed to inject 5-10 mg of regitine (i can’t remember the generic name atm) mixed with saline around the area to prevent necrosis of the tissue.
@Jamie – Howdy, thanks for your comments. I agree, a line is a line – use what you can in a critical situation.