Vasopressin (Surgical — Vasopressor/Haemostasis)

How it works

Acting on vascular V1 receptors it causes intense systemic and splanchnic vasoconstriction, while V2 receptor activity in the kidney promotes water reabsorption; the vasoconstrictor action underlies both its pressor and haemostatic effects.

Prescribing in practice

• Its powerful vasoconstriction can provoke myocardial, mesenteric, digital and cutaneous ischaemia, so it should be given by infusion through secure central access under continuous haemodynamic monitoring, with caution in coronary and peripheral vascular disease.
• Extravasation can cause severe local tissue necrosis, so confirm line integrity before and during the infusion.
• Excess water retention may cause hyponatraemia, requiring attention to fluid balance and sodium.

Monitoring

Monitor blood pressure, cardiac rhythm, peripheral and organ perfusion, urine output, fluid balance and serum sodium continuously during infusion.

Counselling the patient

• This is given and closely monitored by the critical-care team.
• Tell staff about any chest pain or pain in the fingers, toes, or abdomen.

Evidence & guidelines

Vasopressin is established as an adjunct vasopressor in vasodilatory shock, supported by critical-care evidence and the SPC.