Implementation

• High Alert: Vasoactive medications are inherently dangerous. Have second practitioner independently check original order, dose calculations, and infusion pump programming. Establish maximum dose limits. Norepinephrine overdose can result in severe peripheral vasoconstriction with resultant ischemia and necrosis of peripheral tissue. Assess peripheral circulation frequently

• Volume depletion should be corrected, if possible, prior to initiation of norepinephrine

» Heparin may be added to each 500 mL of solution to prevent thrombosis in the infused vein, perivenous reactions, and necrosis in patients with severe hypotension following MI

» Norepinephrine may deplete plasma volume and cause ischemia of vital organs, resulting in hypotension when discontinued, if used for prolonged periods. Prolonged or large doses may also decrease cardiac output

» Infusion should be discontinued gradually, upon adequate tissue perfusion and maintenance of blood pressure, to prevent hypotension. Do not resume therapy unless blood pressure falls to 70–80 mm Hg

• Continuous Infusion:

Diluent: Dilute 4 mg in 1000 mL of D5W or D5/0.9% NaCl. Do not dilute in 0.9% NaCl without dextrose
Concentration: 4 mcg/mL Do not use discolored solutions (pink, yellow, brown) or those containing a precipitate

• Rate:
Titrate infusion rate according to patient response, using slowest possible rate to correct hypotension. Administer via infusion pump to ensure accurate dosage

• Y-Site Compatibility:

» alfentanil

» amikacin

» amiodarone

» anidulafungin

» argatroban

» ascorbic acid

» atracurium

» atropine

» benztropine

» bivalirudin

» bumetanide

» buprenorphine

» butorphanol

» calcium chloride

» calcium gluconate

» carboplatin

» caspofungin

» cefazolin

» cefonicid

» cefoperazone

» cefotaxime

» cefotetan

» cefoxitin

» ceftazidime

» ceftizoxime

» ceftriaxone

» cefuroxime

» chloramphenicol

» chrlopromazine

» cimetidine

» cisatracurium

» cisplatin

» clindamycin

» cyanocobalamin

» cyclophosphamide

» cyclosporine

» cytarabine

» daptomycin

» dexamethasone

» digoxin

» diltiazem

» diphenhydramine

» dobutamine

» docetaxel

» dopamine

» doripenem

» doxycycline

» enalaprilat

» ephedrine

» epinephrine

» epirubicin

» epoetin alfa

» ertapenem

» erythromycin

» esmolol

» etoposide

» etoposide phosphate

» famotidine

» fenoldopam

» fentanyl

» fluconazole

» fludarabine

» gemcitabine

» gentamicin

» glycopyrrolate

» granisetron

» heparin

» hetastarch

» hydrocortisone sodium succinate

» hydromorphone

» ifosfamide

» imipenem/cilastatin

» isoproterenol

» ketorolac

» labetalol

» lidocaine

» linezolid

» lorazepam

» magnesium sulfate

» mannitol

» mechlorethamine

» meperidine

» meropenem

» metaraminol

» methotrexate

» methoxamine

» methyldopate

» methylprednisolone

» metoclopramide

» metoprolol

» metronidazole

» micafungin

» miconazole

» midazolam

» milrinone

» mitoxantrone

» morphine

» multivitamins

» mycophenolate

» nafcillin

» nalbuphine

» naloxone

» nicardipine

» nitroglycerin

» nitroprusside

» octreotide

» ondansetron

» oxacillin

» oxaliplatin

» oxytocin

» paclitaxel

» palonosetron

» papaverine

» pemetrexed

» penicillin G

» pentamidine

» pentazocine

» phentolamine

» phenylephrine

» phytonadione

» piperacillin/tazobactam

» potassium chloride

» procainamide

» prochlorperazine

» promethazine

» propofol

» propranolol

» protamine

» pyridoxime

» ranitidine

» remifentanil

» streoptokinase

» succinylcholine

» sufentanil

» tacrolimus

» teniposide

» theophylline

» thiamine

» thiotepa

» ticarcillin/clavulanate

» tigecycline

» tirofiban

» tobramycin

» tolazoline

» trimetaphan

» urokinase

» vancomycin

» vasorpessin

» vecuronium

» verapamil

» vincristine

» vinorelbine

» vitamin B complex with C

» voriconazole

• Y-Site Incompatibility:
aminophylline
amphotericin B colloidal
azathioprine
dantrolene
diazepam
diazoxide
drotrecogin
folic acid
ganciclovir
indomethacin
pentobarbital
phenobarbital
phenytoin
sodium bicarbonate
thiopental
trimethoprim/sulfamethoxazole

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