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)

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