The administration of dilute solutions of noradrenaline via peripheral venous catheters (PVCs) has gained increasing acceptance in recent years. Large studies have provided reassuring safety data,1 and guidelines recognise this therapy as a short-term measure for blood pressure support,2 particularly in septic shock.3 Despite this the UK critical care community has been slow to accept peripheral noradrenaline; fear of extravasation injury persists in some quarters, and at a recent Investigators’ Meeting of the Early Vasopressors in Sepsis (EVIS) trial this was identified as a significant barrier to recruitment.4

Our Scottish District General Hospital ED introduced a peripheral noradrenaline protocol in 2019 in cooperation with our critical care team, using a concentration of 16 μg/mL.2 Local critical care practice with centrally administered vasopressors is to start infusions at standardised rates independent of patient weight, so the same approach was taken with peripheral noradrenaline. We use infusion rates of 0–13.3 μg/min (0–50 mL/hour) titrated to frequent or continuous blood pressure measurement. Rates may be increased as high as 26.6 μg/min (100 mL/hour) as a bridge to central venous catheter (CVC), or in frailer patients for whom insertion of a CVC is considered too invasive by the treating clinical team. Infusion site …