A systematic review of extravasation and local tissue injury from administration of vasopressors through peripheral intravenous catheters and central venous catheters

Loubani, Osama; Green, Robert S.

doi:10.1016/j.jcrc.2015.01.014

Cited by 184 publications

(231 citation statements)

References 45 publications

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“…Case reports demonstrated that administration of vasopressors greater than 2 hours and placement of the PIV catheter distal to the antecubital fossa were more likely to cause local tissue injury. [12] Overall, no conclusion can be drawn from this systemic review regarding the safety of vasopressors via PIV access. [12] Kahn et al [13] reported a case study of a 46-year-old female with septic shock and severe hypotension.…”

Section: Review Of the Literaturementioning

confidence: 95%

“…[12] Overall, no conclusion can be drawn from this systemic review regarding the safety of vasopressors via PIV access. [12] Kahn et al [13] reported a case study of a 46-year-old female with septic shock and severe hypotension. Vasopressin was started via an 18-gauge PIV catheter in her wrist.…”

Section: Review Of the Literaturementioning

confidence: 95%

“…This study concluded that with careful monitoring and safety protocols, peripheral administration of vasopressors may be acceptable. [11] A systematic review of the literature conducted by Loubani and Green [12] determined that vasopressors can cause tissue damage and limb injury when given via PIV access. Case reports demonstrated that administration of vasopressors greater than 2 hours and placement of the PIV catheter distal to the antecubital fossa were more likely to cause local tissue injury.…”

Section: Review Of the Literaturementioning

confidence: 99%

“…Phenylephrine 80 mg/500 ml NS or 160 mg/500 ml NS 3. Norepinephrine 4 mg/250 NS or 8 mg/250 cc NS Based on the Long Island Jewish Medical Center Adult Guidelines for the Peripheral Administration of Vasopressor Therapy in the Intensive Care Unit (ICU) [12,[20][21][22] .…”

Section: Medicationsmentioning

confidence: 99%

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The development of a nurse-driven protocol for the safe administration of vasopressors through peripheral intravenous catheters

Padrone

Galiczewski

Amitrano

et al. 2018

IJH

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Aim: The purpose of this quality improvement project was to develop a nurse-driven protocol to provide a safer, quicker, and less complication-prone alternative for the administration of vasopressors. Background: The use of vasopressor medication is a common life saving intervention used to achieve hemodynamic stability in critically ill patients. Vasopressor infusions are routinely administered through central venous catheters (CVC) for fear that extravasation into subcutaneous tissue will result in ischemic injury. There are many potential complications of obtaining central venous access for vasopressor use, including pneumothoraces, arterial punctures and hematomas. Design: Quality improvement project. Methods: An interdisciplinary team developed a written protocol for the administration of vasopressors through peripheral intravenous (PIV) catheters based on the available scientific evidence. Key components of this quality improvement project were patient safety, a team approach and skilled monitoring of the infusion site. Critical care nurses were responsible for the line insertion, maintenance and identification of possible extravasation. All catheters placed were confirmed by ultrasonography and if extravasation of medication was suspected, the extravasation protocol was followed without delay. Results: The protocol developed was utilized in a study by Cardenas-Garcia et al. (2015). Extravasation occurred in 19 of 734 patients (2%) without any tissue injury following the use of the extravasation protocol. This evidence-based protocol for peripherally administered vasopressors decreased central line use and the potential complications from the placement of CVCs. Strict adherence to this evidence-based nurse-driven protocol was essential for the safe administration of vasopressors via PIV access. Conclusion/Clinical relevance: Peripheral administration of vasopressors has many beneficial implications for nursing practice. A nurse-driven protocol for peripheral vasopressors can eliminate the need for CVCs, which will reduce the incidence of central line-associated blood stream infections and decrease the number of central line days. This also may eliminate potential complications from CVC placement. Lastly, peripherally administered vasopressors may prevent a delay in treatment often experienced with placement of a central line.

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Section: Review Of the Literaturementioning

confidence: 95%

Section: Review Of the Literaturementioning

confidence: 95%

Section: Review Of the Literaturementioning

confidence: 99%

Section: Medicationsmentioning

confidence: 99%

See 2 more Smart Citations

The development of a nurse-driven protocol for the safe administration of vasopressors through peripheral intravenous catheters

Padrone

Galiczewski

Amitrano

et al. 2018

IJH

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“…In responder patients, resuscitation with volume [108][109][110] can be made, while in the nonresponders, a perfusion of noradrenaline will be initiated [111,112].…”

Section: Hypotensionmentioning

confidence: 99%

Videolaryngoscopy in the Intensive Care Unit: We could Improve ICU Patients Safety

Hurtado¹,

Merchante²,

Ventura³

et al. 2018

Bedside Procedures

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Tracheal intubation is one of the most common and dangerous procedures in the intensive care units (ICU), and is usually done in more difficult conditions than in the operating room. Intubation failure can occur unexpectedly, and is the second most common event reflected in the ICU in the NAP4. Complications associated with airways were more likely to occur in ICU than in the operating room (severe hypoxemia, arrhythmia, hypotension, cardiovascular collapse, etc.), and generates more frequent damage to the patient. The theoretical benefits of videolaryngoscopes, as proper and correct use, offer the potential to reduce the difficulty of intubation in the ICU. In recent years, the role of videolaryngoscopes in ICU has been the subject of debate. Numerous studies have shown increased morbidity when performing multiple attempts at tracheal intubation. Videolaryngoscopes allow a view of the entrance of glottis independent of the line of sight, and have also been shown to improve glottis and intubation success rates in emergency and emergency services, in the prehospital setting, and specifically in patients with known predictors of difficult airway (DA).

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Complication Rates of Central Venous Catheters

Teja,

Bosch,

Diep

et al. 2024

JAMA Intern Med

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ImportanceCentral venous catheters (CVCs) are commonly used but are associated with complications. Quantifying complication rates is essential for guiding CVC utilization decisions.ObjectiveTo summarize current rates of CVC-associated complications.Data SourcesMEDLINE, Embase, CINAHL, and CENTRAL databases were searched for observational studies and randomized clinical trials published between 2015 to 2023.Study SelectionThis study included English-language observational studies and randomized clinical trials of adult patients that reported complication rates of short-term centrally inserted CVCs and data for 1 or more outcomes of interest. Studies that evaluated long-term intravascular devices, focused on dialysis catheters not typically used for medication administration, or studied catheters placed by radiologists were excluded.Data Extraction and SynthesisTwo reviewers independently extracted data and assessed risk of bias. Bayesian random-effects meta-analysis was applied to summarize event rates. Rates of placement complications (events/1000 catheters with 95% credible interval [CrI]) and use complications (events/1000 catheter-days with 95% CrI) were estimated.Main Outcomes and MeasuresTen prespecified complications associated with CVC placement (placement failure, arterial puncture, arterial cannulation, pneumothorax, bleeding events requiring action, nerve injury, arteriovenous fistula, cardiac tamponade, arrhythmia, and delay of ≥1 hour in vasopressor administration) and 5 prespecified complications associated with CVC use (malfunction, infection, deep vein thrombosis [DVT], thrombophlebitis, and venous stenosis) were assessed. The composite of 4 serious complications (arterial cannulation, pneumothorax, infection, or DVT) after CVC exposure for 3 days was also assessed.ResultsOf 11 722 screened studies, 130 were included in the analyses. Seven of 15 prespecified complications were meta-analyzed. Placement failure occurred at 20.4 (95% CrI, 10.9-34.4) events per 1000 catheters placed. Other rates of CVC placement complications (per 1000 catheters) were arterial canulation (2.8; 95% CrI, 0.1-10), arterial puncture (16.2; 95% CrI, 11.5-22), and pneumothorax (4.4; 95% CrI, 2.7-6.5). Rates of CVC use complications (per 1000 catheter-days) were malfunction (5.5; 95% CrI, 0.6-38), infection (4.8; 95% CrI, 3.4-6.6), and DVT (2.7; 95% CrI, 1.0-6.2). It was estimated that 30.2 (95% CrI, 21.8-43.0) in 1000 patients with a CVC for 3 days would develop 1 or more serious complication (arterial cannulation, pneumothorax, infection, or DVT). Use of ultrasonography was associated with lower rates of arterial puncture (risk ratio [RR], 0.20; 95% CrI, 0.09-0.44; 13.5 events vs 68.8 events/1000 catheters) and pneumothorax (RR, 0.25; 95% CrI, 0.08-0.80; 2.4 events vs 9.9 events/1000 catheters).Conclusions and RelevanceApproximately 3% of CVC placements were associated with major complications. Use of ultrasonography guidance may reduce specific risks including arterial puncture and pneumothorax.

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A systematic review of extravasation and local tissue injury from administration of vasopressors through peripheral intravenous catheters and central venous catheters

Cited by 184 publications

References 45 publications

The development of a nurse-driven protocol for the safe administration of vasopressors through peripheral intravenous catheters

The development of a nurse-driven protocol for the safe administration of vasopressors through peripheral intravenous catheters

Videolaryngoscopy in the Intensive Care Unit: We could Improve ICU Patients Safety

Complication Rates of Central Venous Catheters

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