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Norepinephrine pressor infusion withdrawal in a National Health Service hospice
  1. Elizabeth Woods1,
  2. Lisa Baker1 and
  3. Jonathan Hindmarsh1,2
  1. 1Centre for Specialist Palliative Care, St. Benedict's Hospice, Sunderland, UK
  2. 2Pharmacy Department, City Hospitals Sunderland NHS Foundation Trust, Sunderland, UK
  1. Correspondence to Jonathan Hindmarsh, City Hospitals Sunderland NHS Foundation Trust, Sunderland SR4 7TP, UK; jonathan.hindmarsh{at}live.co.uk

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.

  • cancer
  • hospice care
  • norepinephrine
  • norepinephrine
  • septic shock
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Footnotes

  • Twitter @hindmarsh_jon

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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