Delaying vasopressors in shock while waiting for a central line prolongs hypotension. Short-term noradrenaline through a well-sited peripheral cannula is widely accepted in sepsis guidance, provided it is in a large vein, ideally in the antecubital fossa or above, and checked regularly.
Extravasation is the main risk, and it is uncommon with careful monitoring. If it occurs, stop the infusion, leave the cannula in place to aspirate, and follow local protocols, which may include phentolamine. Central access should follow if vasopressors are needed beyond the first few hours or at higher doses.
- Start noradrenaline peripherally rather than delay it for a central line.
- Use a large, proximal vein with a reliable cannula.
- Check the site frequently for blanching, swelling or pain.
- Arrange central access if the infusion continues beyond a few hours or the dose climbs.
Why it matters
Time spent waiting for a central line is time spent hypotensive.
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