Pressor Points - Evaluating the Protocolized Use of Peripherally Administered Norepinephrine

Document Type

Conference Proceeding

Publication Date

3-6-2026

Publication Title

Am J Health Syst Pharm

Keywords

Pharmacology & Pharmacy

Abstract

Purpose: Norepinephrine is a first-line vasopressor utilized for life-threatening hypotension, which historically was recommended to be administered via a central venous catheter (CVC) to avoid extravasation and tissue injury. However, CVC placement can cause delays in vasopressor initiation and carries risks including infection and thrombosis. To address these concerns, guidelines as well as recent literature now support protocolized peripheral norepinephrine administration, leading many institutions to standardize its use. This study aims to evaluate compliance and safety of an institution’s peripheral norepinephrine protocol. Methods: This IRB-approved, retrospective, descriptive medication use evaluation included adult patients admitted to one of five included hospitals in the health system between September 1, 2024, and August 31, 2025, who received peripheral norepinephrine. Data was extracted from electronic health records using Structured Query Language (SQL). Patients were randomized using a random number generator until a total of 100 patients were obtained, with 10% of the extracted data evaluated for accuracy. Protected populations, those who received peripheral norepinephrine exclusively in the operating room, transitioned to hospice, expired within 24 hours of initiation, transferred from outside facilities, or received other peripheral vasopressors prior to or during norepinephrine administration were excluded. The primary outcome was to assess protocol compliance. Secondary outcomes included the incidence and type of protocol deviations, rate of CVC placement following peripheral norepinephrine initiation, and extravasation events including frequency, severity, and management. Categorical variables were analyzed using frequency distributions, while continuous variables were reported as mean with standard deviation and median with intra-quartile range

Volume

83

First Page

S804

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