Safety of the Peripheral Administration of Vasopressor Agents

Abstract

Vasopressors are an integral component of the management of septic shock and are traditionally given via a central venous catheter (CVC) due to the risk of tissue injury and necrosis if extravasated. However, the need for a CVC for the management of septic shock has been questioned, and the risk of extravasation and incidence of severe injury when vasopressors are given via a peripheral venous line (PVL) remains poorly defined. We performed a retrospective chart review of 202 patients who received vasopressors through a PVL. The objective was to describe the vasopressors administered peripherally, PVL size and location, the incidence of extravasation events, and the management of extravasation events. The primary vasopressors used were norepinephrine and phenylephrine. The most common PVL sites used were the forearm and antecubital fossa. The incidence of extravasation was 4%. All of the events were managed conservatively; none required an antidote or surgical management. Vasopressors were restarted at another peripheral site in 88% of the events. The incidence of extravasation was similar to prior studies. The use of a PVL for administration of vasopressors can be considered in patients with a contraindication to a CVC.

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

“…[10] This study suggested that the administration of vasopressors through a CVC may not be a necessity for all patients. [10] In a 6-month pilot study, phenylephrine was administered via PIV access in 20 patients with one minor complication and no major injuries. [11] This was achieved by implementing safety measures in the computerized physician order entry system (CPOE) and by utilizing nurse-driven protocols.…”

“…A retrospective chart review of vasopressor administration through a PIV catheter demonstrated a 4% overall incidence of extravasation events when a strict safety protocol was not in place. [10] None of these events were severe enough to require intervention and vasopressors were resumed in a new peripheral site most of the time. [10] This study suggested that the administration of vasopressors through a CVC may not be a necessity for all patients.…”

“…[10] None of these events were severe enough to require intervention and vasopressors were resumed in a new peripheral site most of the time. [10] This study suggested that the administration of vasopressors through a CVC may not be a necessity for all patients. [10] In a 6-month pilot study, phenylephrine was administered via PIV access in 20 patients with one minor complication and no major injuries.…”

Initiation of vasopressor infusions via peripheral versus central access in patients with early septic shock: A retrospective cohort study

“…Norepinephrine was used in 50 of 55 cases, with local extravasation in two patients and one patient developing thrombophlebitis. Another retrospective observational study used data from 202 patients, admitted to the ICU of an academic teaching hospital, who received vasopressor infusion via a PVC . In this cohort, with 73% of patients diagnosed with septic shock, the majority (72%) received norepinephrine and extravasation events occurred in 4% of patients.…”

Liberal Versus Restrictive Intravenous Fluid Therapy for Early Septic Shock: Rationale for a Randomized Trial

“…Historically, the common practice of requiring central venous access for vasopressor infusion hampered early use of vasopressors. 34,35 However, current data suggest that norepinephrine administration through large peripheral intravenous catheters for short intervals (hours to days) with appropriate monitoring is safe, 36–37 facilitating early vasopressor use for sepsis resuscitation.…”