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Vasopressors...The central and Peripheral doses

Central lines offer good vascular access for the infusion of pressors and inotropes. It is important to mention that central access is preferred for infusion of those medications because of the concern for peripheral vascular and tissue damage. The problem with pressors delivered peripherally is with infiltration. A long peripheral IV placed in a good vein could certainly be used to deliver pressors but the risk of skin necrosis and its implications (infection, need for grafting) is just too high. Some institutions however have been using more dilute formulations of certain pressors for peripheral use. There is no data supporting this but institutional records have shown it to be safe. Please keep in mind you should make sure to stay within your institution’s guidelines for the use of pressors. Your pharmacy needs to be on board with this as they are responsible for mixing/diluting the meds and dispensing them. The dilution would also have to be compatible with pump presets and can therefore change from institution to institution. Here are a few examples of formulations currently in use.
  • Norepinephrine 8mg/250mL D5W/NS (Central)
  • Norepinephrine 4mg/250mL D5W/NS (Peripheral)
  • Epinephrine 4mg/250mL D5W/NS (Central)
  • Epinephrine 1mg/250mL D5W/NS (Peripheral)
  • Phenylephrine 80mg/250mL D5W/NS (Central)
  • Phenylephrine 10mg/250mL D5W/NS (Peripheral)
  • Vasopressin 40units/250mL D5W/NS (Central)
  • Vasopressin 20units/250mL D5W/NS (Peripheral)
  • Dopamine 800mg/250mL D5W/NS (Central)
  • Dopamine 400mg/250mL D5W/NS (Peripheral)
  • Dobutamine 1000mg/250mL D5W/NS (Central)
  • Dobutamine 500mg/250mL D5W/NS (Peripheral)
  • Milrinone 40mg/100mL D5W/NS (Central)
  • Milrinone 20mg/100mL D5W/NS (Peripheral)
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