Peripheral Noradrenaline Administration — FRCA Final MCQ

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ModerateIntensive Care MedicinePeripheral Noradrenaline AdministrationFRCA Final

A 65-year-old man in ICU with septic shock is started on a noradrenaline infusion via a peripheral 18G cannula in the right antecubital fossa because central venous access is not yet available. What is the most serious risk of peripheral noradrenaline administration?

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Correct answer: E — Tissue necrosis from extravasation

Peripheral administration of noradrenaline carries a risk of severe tissue necrosis if extravasation occurs, due to intense local vasoconstriction. However, current evidence and ICU guidelines accept short-term peripheral noradrenaline administration (via a large proximal vein, ideally antecubital fossa, through a well-functioning cannula with hourly checks) as a bridge while central access is being established. This avoids delays in vasopressor therapy. If extravasation occurs, phentolamine infiltration (5-10 mg in 10 mL saline) can reverse the vasoconstriction.

Reference: ICS – 2023 – Vasopressor administration guidelines; Cardenas-Garcia J – 2015 – Safety of peripheral vasopressors