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

Marqués, Catalina González; Mwemerashyaka, Lucien; Martin, Kyle Denison; Tang, Oliver Y.; Uwamahoro, Chantal; Ndebwanimana, Vincent; Uwamahoro, Doris; Moretti, Katelyn; Sharma, Vinay; Naganathan, Sonya; Ling, Jing; Garbern, Stephanie Chow; Nkeshimana, Menelas; Levine, Adam C.; Aluisio, Adam R.

doi:10.1016/j.afjem.2022.03.006

Cited by 5 publications

(4 citation statements)

References 26 publications

(43 reference statements)

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“…As such, they are frequently used for intubated admitted patients who are waiting for an available ICU bed and are infrequently available for BIPAP and CPAP which is likely the reason only 1.0% of patients received NIPPV. Similarly, a 2019 study of 64 patients from KUTH reported CVC placement in 11% of patients who required vasopressors (22). In our cohort of critically ill patients, only six had a CVC placed.…”

supporting

confidence: 62%

Epidemiology and outcomes of critically ill patients in the Emergency Department of a tertiary teaching hospital in Rwanda

B.,

Bearnot,

Martin

et al. 2024

Preprint

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Background The introduction of Emergency Medicine in Rwanda in 2015 has been associated with a mortality reduction in patients presenting to Kigali University Teaching Hospital (KUTH). In the context of increasing numbers of critically ill patients presenting to EDs globally, the aim of this study was to describe the characteristics of critically ill patients, the critical care interventions performed, and the outcomes of critically ill patients presenting to the KUTH ED with the goal of informing future research into the root causes of mortality of critically ill ED patients and of identifying high yield topics for didactic and procedural training. Methods A descriptive prospective cohort pilot study analyzed all patients ≥15 years who presented to KUTH between April and June 2022 with modified South African Triage Scores of Red with alarm, Red without alarm, and Orange. Results Of 320 patients, 66.9% were male and median age was 40 years. Patients were triaged as Orange (65.3%), Red without alarm (22.8%), and Red with alarm (11.9%). Presentations were categorized as: medical emergencies (48.0%), traumatic injury (44.5%), and surgical emergencies (7.6%). Median length of stay was 31 hours (IQR 28, 56) and boarding was 23 hours (IQR 8, 48). Overall mortality was 12.2% and highest among medical emergencies (16.5%, p = 0.048) and increased significantly with triage color: Red with alarm (47.4%), Red without alarm (16.4%), and Orange (4.3%, p < 0.0001). Cardiopulmonary resuscitation (CPR) (10.3%), endotracheal intubation (8.8%), and vasopressor administration (3.1%) were the most frequent critical interventions performed. Survival after cardiac arrest was 9.1% and 32.1% after intubation. Mortality was associated with the following interventions: CPR, intubation, and use of vasopressors (p < 0.05). Conclusions This pilot study identified the most common critical care interventions performed and a high mortality among patients who required these interventions in the ED of a tertiary teaching hospital in Rwanda. These findings will inform didactics and procedural training for emergency care providers. Future research should focus on the root causes of mortality in these specific patient populations and identify areas of system strengthening to reduce mortality.

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supporting

confidence: 62%

Epidemiology and outcomes of critically ill patients in the Emergency Department of a tertiary teaching hospital in Rwanda

B.,

Bearnot,

Martin

et al. 2024

Preprint

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“…However, infusion of vasopressors through a PIVC is sometimes performed to hasten the administration of this therapy in critically ill patients [31]. Although extravasation rates related to vasopressor use have ranged across studies from 0% to 13%, most studies reported a rate less than 5% with PIVCs, including a systematic review of seven studies (Table 3) [32][33][34][35][36]. Risk factors for vasopressor-related extravasation are both modifiable and nonmodifiable and include those related to the infusate (dose, rapid rate, high volume, prolonged or peripheral administration, saline concentration, pH, and osmolarity), procedure (e.g., catheter Volume 6; Issue 06 Int J Nurs Health Care Res, an open access journal ISSN: 2688-9501 type), and patient characteristics (e.g., hemodynamic instability) [17,37,38].…”

Section: Infusate Types As Risk Factorsmentioning

confidence: 99%

“…French prospective study at an infectious disease unit (n = 509) 4.5% [15] Chinese retrospective study at a hospital (n = 694,043) b 0.038% German prospective study of patients undergoing contrast-enhanced CT (n = 3,514) 0.71% [55] Australian retrospective analysis of CT/PET study (n = 296) 1.3% [57] Study pooling PET and CT scans from U.S. and Australia (n = 863) 6.7% [58] A quality improvement CT/PET study (n = 5,541) 6.2% d [56] U.S. study -national benchmark rate from 11 cancer centers (739,812 infusions) 0.09% [40] Retrospective study at a U.S. community cancer center (12,872 infusions) 0.17% [41] Japanese cross-sectional observational study of patients undergoing chemotherapy (n = 12,475) 0.18% [42] Japanese cross-sectional observational study of patients undergoing chemotherapy (n = 24) 4.2% [43] Japanese prospective study of outpatient chemotherapy (n = 41) 0% [45] Japanese prospective study of outpatient chemotherapy (n = 63) 0% [44] SLR of 7 studies on complications after PIVC-infused vasopressors (n = 1,382) 3.4% [32] Dutch retrospective study on PIVC-infused norepinephrine (n = 14,385) 0.035% [33] U.S. retrospective study of long-term use of vasopressors by midlines (n = 248) 0.004% [34] Australian retrospective study of critically ill patients receiving vasopressors (n = 212) 13% [35] Rwandan prospective cohort study of critically ill patients receiving vasopressors (n = 64) 2.9% [36] a Adjusted complication rate. b Study includes different drugs including hypotonic or hypertonic drugs, contrast media, strong acid or alkali drugs, antineoplastic agents, inotropic agents, and other drugs.…”

Section: Infiltrationmentioning

confidence: 99%

The Clinical and Economic Burdens of Infiltration and Extravasation with Peripheral Intravenous Catheters: A Contemporary Narrative Review

2023

Int J Nurs Health Care Res

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Infiltration and extravasation are complications of peripheral intravenous catheter (PIVC) use, and some of the most common causes of catheter failure. The objective of this contemporary review is to characterize the incidence, risk factors, and clinical and economic consequences of PIVC-related infiltration and extravasation, as well as strategies for prevention. Recent evidence demonstrates that infiltration incidence ranges from 13% to 20%. Extravasation is less frequent, with a reported incidence of up to 4.5%. There are numerous patient and procedure-related factors that increase the risk of infiltration and extravasation, which are caused by the infusion of either a non-vesicant or vesicant, respectively. Infiltration is often perceived as a minor complication, but can result in skin damage (e.g., scars, blisters), infections, and nerve damage, amongst other injuries, while extravasation can occasionally lead to severe consequences such as tissue necrosis and even limb loss. Both infiltration and extravasation may require additional venipunctures, resulting in treatment delays and patient discomfort. In addition to the clinical consequences, infiltration and extravasation are associated with high economic burden. This review also highlights how different considerations should be taken based on the type of extravasations that may occur with PIVC administration of contrast media, radiopharmaceuticals, vasopressors, and chemotherapy. Ultimately, use of PIVCs requires careful risk assessment and mitigation, effective monitoring and diagnosis, and timely treatment to prevent or minimize the unnecessary burdens of infiltration and extravasation for the patient and healthcare system.

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“…When vasoactive drugs cause the contraction of small veins or arterioles, it reduces blood flow, leading to tissue necrosis and potentially causing infusion extravasation. 15…”

Section: Increased Venous and Hydrostatic Pressuresmentioning

confidence: 99%

Factors Influencing Extravasation of Newborn Intravenous Infusions: A Review

Huang,

Liao

et al. 2023

Explor Res Hypothesis Med

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Newborns, with their low immune system, lack of self-care ability, and inability to express discomfort through language, face challenges during the treatment of diseases, especially during intravenous infusion treatments where extravasation can occur. The inability of nurses to immediately detect extravasation often leads to severe consequences, including disability and even death. This increases the pain and treatment costs for children and places a heavy burden on healthcare professionals, hospitals, and society. Neonatal infusion extravasation is widespread during intravenous infusion and is influenced by various factors. Therefore, this article aims to review the research progress on relevant influencing factors that cause neonatal infusion extravasation.

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

Cited by 5 publications

References 26 publications

Epidemiology and outcomes of critically ill patients in the Emergency Department of a tertiary teaching hospital in Rwanda

Epidemiology and outcomes of critically ill patients in the Emergency Department of a tertiary teaching hospital in Rwanda

The Clinical and Economic Burdens of Infiltration and Extravasation with Peripheral Intravenous Catheters: A Contemporary Narrative Review

Factors Influencing Extravasation of Newborn Intravenous Infusions: A Review

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