(1649) Evaluation of Prescribing Practices of Peripherally Administered Norepinephrine

Introduction: Norepinephrine (NE) is a frequently used vasoactive medication for the treatment of shock. Central venous administration of NE is preferred to mitigate extravasation and tissue injury with peripheral administration; however, central lines may pose an increased risk for infection. In 2021, a hospital-wide policy for peripheral NE administration (pNE) was established. The objective of this review was to evaluate adherence to the pNE policy and characterize the use of pNE in adult patients.

Methods: This single-center IRB-approved retrospective review included adult patients (≥ 18 years) who received pNE between June 2022 and May 2023. Patients were arranged in a random order and consecutive patients were screened for inclusion until 100 was reached. The primary endpoint was policy compliance, defined by availability of a 20 gauge or larger catheter, availability of a backup catheter, and a maximum pNE dose ≤ 15 mcg/min. Secondary endpoints included extravasation events, central line placement, and central line days avoided per patient. Central line days avoided were calculated as the number of calendar days in which pNE was infused. Descriptive statistics were used to characterize the data, and statistical comparisons of pNE initiation and maximum dose were assessed using Mann Whitney U test.

Results: Adherence to the pNE policy was observed in 60% of the 100 patients. There was at least one peripheral line with a 20 gauge or larger catheter available in 92% of patients; however, only 65% of patients had a backup peripheral line. The maximum pNE dose was ≤ 15 mcg/min in 96% of patients. A central line was placed in 37% of patients. The pNE dose at initiation was 2.0 mcg/min [IQR 2.0-5.0]. The maximum pNE dose in patients who did and did not have a central line placed was 13 mcg/min [IQR 7-15] and 6 mcg/min [IQR 4-10], respectively (p= < 0.001). There was a median of 1 [IQR 0-2] central line day avoided. There were four documented extravasation events, with all 4 patients subsequently having a central line placed.

Conclusions: Non-adherence to the pNE policy was observed in 40% of patients, primarily due to lack of a backup peripheral line. Central line placement was avoided in 63% of patients, with a median of 1 central line day avoided. Peripheral NE was well tolerated.