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Background/Objectives: In Japan, evidence on catecholamine syringe exchange methods is limited, with practices varying across facilities and individuals. In this study, we aimed to determine the effect of the catecholamine syringe exchange method on blood pressure variability in intensive care unit patients. Methods: We retrospectively analyzed 119 patients (308 syringe exchanges) who underwent catecholamine syringe exchange between 1 April 2020 and 31 March 2022. Patient characteristics for the double-pumping changeover (DPC) and quick syringe changeover (QC) groups were matched and compared using propensity scores. A sub-analysis focused on patients with severe shock with systolic blood pressures ≤ 90 mmHg. Logistic regression analysis was used to examine factors influencing blood pressure variability during the catecholamine syringe changeover. Results: Neither propensity score matching nor the sub-analysis for patients with shock revealed significant differences in the coefficient of variation or absolute systolic/diastolic/mean blood pressure within 15 min of syringe exchange in the two groups. Logistic regression revealed that age was the sole risk factor affecting blood pressure variability during syringe changeover (odds ratio: 1.018, 95% confidence interval: 1.001–1.036), while syringe changeover methods did not contribute to circulating variability (odds ratio: 1.186, 95% confidence interval: 0.672–2.092). Conclusions: Differences between the DPC and QC methods did not significantly affect blood pressure variability during catecholamine syringe changeovers. However, in older adult patients, catecholamine syringe changeover may be more likely to cause blood pressure variability. Full article