Who can administer
Administration RESTRICTED - see Appendix 1
Important information
- Central line administration: administration by infusion in specialist units only - (critical care only)
- Peripheral line administration (restricted use - Critical Care, Outreach ONLY)
- Resuscitation use: any area
- Infusion route is an unlicensed method of administration
- For Y-site compatibility see below
Available preparations
Adrenaline 1mg in 1mL ampoule (1:1000) (Mercury)
Adrenaline 1mg in 10mL pre-filled syringe (1:10,000) (Aurum)
Adrenaline 100 microgram in 1mL ampoule (Martindale)- for use in neonates
Reconstitution
Pre-filled syringe
Ampoule
- Already in solution
- Dilute further prior to administration
- Draw up using a 5 micron filter needle
Infusion fluids
Glucose 5% (preferred (ref 3)) or Sodium chloride 0.9%
Methods of intravenous administration
Bolus intravenous injection
- Resuscitation: as per GUH guidelines
- Pre-filled syringes are used as supplied
- Ampoules are to be diluted before use
Continuous intravenous infusion (using an electronically controlled infusion device)
- Central line administration
- Prepare a solution containing either 3mg in 50mL, or 6mg in 50mL
- A 3mg per 50mL solution contains 60 micrograms per mL
- A 6mg per 50mL solution contains 120 micrograms per mL
- Administer at a suitable rate, titrated to response - see 'dose' below
Dose in adults
Bolus intravenous injection: as per resuscitation guidelines
- Pre-filled syringes are used as supplied
- Ampoules are to be diluted before use
Continuous intravenous infusion - CENTRAL LINE (Critical Care only) (ref 2)
- Initial rate: 1 microgram per minute, titrated to effect
Continuous intravenous infusion - PERIPHERAL LINE (Restricted use - Critical Care, Outreach ONLY)
- Anaphylaxis (refractory to IM adrenaline) (ref 2,4)
- Initial rate advised at 0.1microgram per kilogram per minute
- Increase rate every two to three minutes by 0.05 mcg/kg/minute until BP and perfusion improve. (see table below for mL/hour volume rate for microgram/kg/minute dosing)
- See Table 1 below and also Guideline for the use of vasopressor agents by peripheral infusion, UHG
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Table 1: Peripheral line (restricted use - Critical Care, Outreach ONLY)
Indication: Anaphylaxis (refractory to IM adrenaline) (ref 2,4)
Rate (mL/hour) for microgram/kg/min doses using 4mg/250mL infusion
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Dosage (microgram/kg/minute)
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50kg patient
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75kg patient
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100kg patient
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0.1microgram/kg/minute
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19 mL/hr
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28 mL/hr
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38 mL/hr
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0.2microgram/kg/minute
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38 mL/hr
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56 mL/hr
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75 mL/hr
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0.3microgram/kg/minute
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56 mL/hr
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84 mL/hr
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113 mL/hr
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0.4microgram/kg/minute
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75 mL/hr
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113 mL/hr
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150 mL/hr
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0.5microgram/kg/minute
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94 mL/hr
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141 mL/hr
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188 mL/hr
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| Doses rounded for convenience |
- Peripheral venous access (ref 1):
- should ideally be of size 20G or more
- be sited proximal to the wrist in the arm
- avoid sites of flexion in awake patients
- avoid sites requiring more than one venepuncture
- there should be a return of blood following insertion and flush easily with 5-10mL of 0.9% sodium chloride
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Monitoring
- Monitor infusion site frequently - extravasation may cause local tissue necrosis
- Monitor blood pressure continuously
- Monitor blood glucose whilst on continuous infusion (ref 3)
- Peripheral administration: a staff member competent in the administration of peripheral vasopressor MUST supervise the patient
Further information
- If PERIPHERAL line extravasation occurs, see Guideline for the use of vasopressor agents by peripheral intravenous infusion, UHG
- If CENTRAL line extravasation occurs, give phentolamine subcutaneously (into site of extravasation) 5 to 10mg in 10 to 20mL Sodium chloride 0.9% (ref 2)
Storage
Store below 250C
References
Adrenaline 1: 1,000 (Mercury) SPC August 2018
Adrenaline 1:10,000 (Martindale)
1: Adult Critical Care Patients. Version 1.1 November 2022 (interim update)
Available from: Intensive Care Society | Vasopressor Agents in Adult ICU (ics.ac.uk) Accessed: 11th July 2023
2: UpToDate (Adrenaline)- accessed online 28th December 2023
3: Injectable medicines guide, Accessed via Medusa 28th December 2023
4: Guideline for the use of vasopressor agents by peripheral infusion, UHG, January 2024
Therapeutic classification
Adrenergic agent/inotrope
