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Woods E, Baker L, Hindmarsh J. Norepinephrine pressor infusion withdrawal in a National Health Service hospice. BMJ Support Palliat Care. 2019;doi: 10.1136/bmjspcare-2019-001895.
Woods, E., Baker, L., & Hindmarsh, J. (2019). Norepinephrine pressor infusion withdrawal in a National Health Service hospice. BMJ supportive & palliative care, . https://doi.org/10.1136/bmjspcare-2019-001895
Woods, Elizabeth, et al. "Norepinephrine pressor infusion withdrawal in a National Health Service hospice." BMJ supportive & palliative care vol. (2019). doi: https://doi.org/10.1136/bmjspcare-2019-001895
Woods E, Baker L, Hindmarsh J. Norepinephrine pressor infusion withdrawal in a National Health Service hospice. BMJ Support Palliat Care. 2019 Sep 28; doi: 10.1136/bmjspcare-2019-001895. Epub 2019 Sep 28. PMID: 31563862.
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BMJ Support Palliat Care. 2019 Sep 28; doi: 10.1136/bmjspcare-2019-001895. Epub 2019 Sep 28.

Norepinephrine pressor infusion withdrawal in a National Health Service hospice.

BMJ supportive & palliative care

Elizabeth Woods, Lisa Baker, Jonathan Hindmarsh

Affiliations

  1. Centre for Specialist Palliative Care, St. Benedict's Hospice, Sunderland, UK.
  2. Centre for Specialist Palliative Care, St. Benedict's Hospice, Sunderland, UK [email protected].
  3. Pharmacy Department, City Hospitals Sunderland NHS Foundation Trust, Sunderland, UK.

PMID: 31563862 DOI: 10.1136/bmjspcare-2019-001895

Abstract

Norepinephrine (NE) is a peripheral vasoconstrictor used as an emergency measure to restore blood pressure secondary to acute hypotension. NE must be administered centrally as a continuous infusion and requires intensive monitoring. Consequently, its use is restricted to critical care environments. We discuss the withdrawal of NE in a hospice for a patient with advanced malignancy and profound hypotension from sepsis. The patient was admitted to intensive care but chose to stop active treatment and insisted on being discharged. Due to concerns about withdrawing NE in the community, he was transferred to a local hospice. We describe various challenges, including the administration and monitoring of NE outside of intensive care, the withdrawal process and concerns that profound hypotension might compromise subcutaneous medications absorption.

© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.

Keywords: cancer; hospice care; norepinephrine; septic shock

Conflict of interest statement

Competing interests: None declared.

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