ResusX:ReWired: Peripheral Pressors

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Glorilyn Ong
Glorilyn Ong

ResusX:ReWired Volunteer

Dr. Salim Rezaie gave an amazing lecture last year during ResusX:ReWired. The pearls from the lecture are found below.

Check out the video, read the notes below, and then register here for ResusX:ReLoaded. The conference will be even bigger and better than ever before!

Use of peripheral pressors (particularly Norepinephrine) is ready for primetime and Dr. Rezaie gave six pearls to consider:

  • #1 Choose Proximal veins
    • Bigger diameter = Bigger target (easier to hit and less chances of back wall puncture)
  • #2 Use Long catheter
    • Longest catheter that will get you the most catheter into the vein: most of the time 4.78cm (1.88in)
  • #3 Limit Time of Infusion
    • 2 to 4 hours
    • The longer you let it run, the more chance of extravasation
  • #4 Use a Dilute Concentration + Small Volume
    • 4mg Norepinephrine in 250mL volume
  • #5 Have an Observation protocol
    • Need not to be complicated
    • As simple as someone (i.e. nurse) keeping an eye on the catheter site every 15 to 30 minutes
  • #6 Must have an Extravasation protocol
    • How Dr. Rezaie handles extravasation events:

> Disconnect the pressor and connect to a different site

> Leave the catheter in

> Connect a syringe to the catheter and suck out what you can

> Give any of the following:

Phentolamine: 5mg/mL x2 in 8mL NS = total volume 10mL (5mL into the catheter & 5mL subcutaneously)

Terbutaline: 1mg/mL in 9mL NS = total volume 10mL (5mL into the catheter & 5mL subcutaneously)

Other options: Nitro paste – not for hypotensive patients; Warm compress and arm elevation (avoid burning the skin)

Did you miss ResusX?Don’t sweat it…we have the video free for you right here

Don’t miss ResusX 2021…sign up here before all tickets are gone

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