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

Abstract

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.

Utilisation of peripheral vasopressor medications and extravasation events among critically ill patients in Rwanda: A prospective cohort study

“…This is among the first prospective studies examining vasopressor administration via PIV access in LMICs. The current findings are concordant with prior literature which describes use of PIV with low extravasation events and few associated severe complications [ 6 , 10 , 11 , 21 ]. Vasopressor medications are a crucial clinical tool in the management of patients with haemodynamic instability and shock [ 9 , 22 ].…”

“…The primary outcome of interest was extravasation events with PIV administration of vasopressor medications, consistent with prior literature [6] , [7] , [8] , [9] , [10] , [11] . Extravasation was treated as a binary outcome of yes or no .…”

“…The majority of the data that exists is based on low-quality evidence from case reports and case series [ 5 , 6 ]. The limited results from studies that have examined the administration of vasopressors administered through PIV have found rates of extravasation of 2-4% [6] , [7] , [8] , [9] , [10] , [11] . This limited data is derived predominantly from HICs, with a paucity of research from LMICs with associated higher mortality from critical illness [ 6 , 12 ].…”

Reducing Central Line Utilization by Peripherally Infusing Vasopressors

“…That project highlighted potential benefits to nursing practice, including reducing central line days and CLABSIs and preventing delays in treatment. 14 Midline catheters are a type of peripheral IV catheter inserted into a deeper vein in the upper arm with the tip terminating at or just below the axillary vein. They have a longer dwell time and lower failure rate than standard peripheral IV catheters.…”

Eventos adversos associados ao uso de vasopressores em cateter venoso periférico: revisão integrativa

“…Assim, o uso precoce de vasopressores em CVP com monitoramento P á g i n a | 702 rigoroso, segurança, tempo ideal, seguindo-se protocolos de administração pode resultar em melhores desfechos/evolução. Embora a infusão em CVP apresente riscos ao paciente, as complicações normalmente tem baixa gravidade e tratamento conservador (TIAN et al, 2019;PADRONE, 2018;LEWIS, et al, 2017).…”