Adrenaline (epinephrine) Intravenous for Adults

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

  • Already in solution

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

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

Dosage (microgram/kg/minute)

50kg patient

75kg patient

100kg patient

0.1microgram/kg/minute

19 mL/hr

28 mL/hr

38 mL/hr

0.2microgram/kg/minute

38 mL/hr

56 mL/hr

75 mL/hr

0.3microgram/kg/minute

56 mL/hr

84 mL/hr

113 mL/hr

0.4microgram/kg/minute

75 mL/hr

113 mL/hr

150 mL/hr

0.5microgram/kg/minute

94 mL/hr

141 mL/hr

188 mL/hr

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

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