For a norepinephrine infusion in septic shock, which intravenous access is preferred?

For a norepinephrine infusion in septic shock, which intravenous access is preferred?

• A. Implanted port
• B. Midline catheter
• C. 18-gauge peripheral venous catheter
• D. Peripherally inserted central catheter (PICC) line

Answer: (D)

When giving a norepinephrine infusion, you want reliable central venous access because norepinephrine is a powerful vasoconstrictor and can cause tissue damage if it leaks into surrounding tissue (extravasation). Central lines place the catheter tip in a central vein, reducing the risk of local tissue injury and allowing safe administration of high-dose vasopressors. A peripherally inserted central catheter line provides central venous access with the tip in a large central vein, making it appropriate for continuous, high-dose infusions required in septic shock. It combines the benefits of central access with relatively rapid placement and suitability for ongoing therapy. In contrast, a midline catheter stays in peripheral veins and doesn’t reach the central circulation, increasing the risk that the medication infiltrates the surrounding tissue. An implanted port is designed for intermittent use and venous access via a subcutaneous reservoir, making it less ideal for urgent, continuous vasopressor support. A peripheral 18-gauge IV is faster to place but carries a higher risk of infiltration for vasopressors and may not be as stable for ongoing high-dose therapy.

When giving a norepinephrine infusion, you want reliable central venous access because norepinephrine is a powerful vasoconstrictor and can cause tissue damage if it leaks into surrounding tissue (extravasation). Central lines place the catheter tip in a central vein, reducing the risk of local tissue injury and allowing safe administration of high-dose vasopressors.

A peripherally inserted central catheter line provides central venous access with the tip in a large central vein, making it appropriate for continuous, high-dose infusions required in septic shock. It combines the benefits of central access with relatively rapid placement and suitability for ongoing therapy.

In contrast, a midline catheter stays in peripheral veins and doesn’t reach the central circulation, increasing the risk that the medication infiltrates the surrounding tissue. An implanted port is designed for intermittent use and venous access via a subcutaneous reservoir, making it less ideal for urgent, continuous vasopressor support. A peripheral 18-gauge IV is faster to place but carries a higher risk of infiltration for vasopressors and may not be as stable for ongoing high-dose therapy.