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Safety and efficacy of peripheral versus centrally administered vasopressor infusion: A single-centre retrospective observational study

Published:September 29, 2021DOI:https://doi.org/10.1016/j.aucc.2021.08.005

      Abstract

      Background

      Shock affects one-third of patients admitted to intensive care and is associated with increased mortality. Vasopressor medications are used to maintain blood pressure in shock. Central venous catheters are associated with serious complications and pose logistical difficulties for insertion. Delivery of vasopressors via peripheral intravenous cannula may be a safe alternative.

      Methods

      This is a retrospective cohort study comparing safety profile and outcomes of vasopressor delivery via peripheral and central routes in critically ill patients over a 12-month period in a mixed medical-surgical intensive care unit. Demographics, clinical characteristics, treatments, and safety outcome data were extracted from medical records. Patients were classified into three groups: vasopressor infusions via peripheral intravenous cannula, combined peripheral intravenous cannula followed by central venous catheter, and central venous catheter only. Groups were compared using the Kruskal–Wallis test for continuous variables and Fisher's exact test for categorical variables. The impact of duration of vasopressor infusion on complication rates was assessed using logistic regression.

      Results

      We identified 212 patients who received vasopressor infusion, 39 received via peripheral only (Group 1), 155 via peripheral followed by central (Group 2), and 18 via central only (Group 3). There were some baseline differences between groups. Group 1 had the lowest median Acute Physiology and Chronic Health Evaluation III score (64, interquartile range = 44–77), and Group 3, the highest (86, interquartile range = 57–101). Duration of vasopressor infusion was shortest in Group 1 and longer in Groups 2 and 3. There were no major complications; however, minor complications such as leakage, extravasation, and erythema occurred in 41% of Group 1 and 28% of Group 2 patients. Duration of peripheral vasopressor infusion was not associated with an increased risk of complications.

      Conclusions

      Administration of vasopressor infusions for short duration in critically ill patients via a peripheral venous cannula may be feasible, with low rates of complications, and offers a safe alternative to central venous access.

      Keywords

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      References

        • Sakr Y.
        • Reinhart K.
        • Vincent J.L.
        • Sprung C.L.
        • Moreno R.
        • Ranieri V.M.
        • et al.
        Does dopamine administration in shock influence outcome? Results of the sepsis occurrence in acutely ill patients (SOAP) study.
        Crit Care Med. 2006; 34: 589-597
        • Cecconi M.
        • De Backer D.
        • Antonelli M.
        • Beale R.
        • Bakker J.
        • Hofer C.
        • et al.
        Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine.
        Intensive Care Med. 2014; 40: 1795-1815
        • Vincent J.L.
        • De Backer D.
        Circulatory shock.
        N Engl J Med. 2013; 369: 1726-1734
        • Weil M.H.
        Personal commentary on the diagnosis and treatment of circulatory shock states.
        Curr Opin Crit Care. 2004; 10: 246-249
        • Hiemstra B.
        • Eck R.J.
        • Keus F.
        • Van Der Horst I.C.C.
        Clinical examination for diagnosing circulatory shock.
        Curr Opin Crit Care. 2017; 23: 293-301
        • Hollenberg S.M.
        Vasoactive drugs in circulatory shock.
        Am J Respir Crit Care Med. 2011; 183: 847-855
        • Permpikul C.
        • Tongyoo S.
        • Viarasilpa T.
        • Trainarongsakul T.
        • Chakorn T.
        • Udompanturak S.
        Early use of norepinephrine in septic shock resuscitation (CENSER) a randomized trial.
        Am J Respir Crit Care Med. 2019; 199: 1097-1105
        • Kwon J.W.
        • Hong M.K.
        • Park B.Y.
        Risk factors of vasopressor-induced symmetrical peripheral gangrene.
        Ann Plast Surg. 2018; 80: 622-627
        • McGee D.
        • Gould M.
        Preventing complications of central venous catheterization.
        N Engl J Med. 2003; 348: 1123-1133
        • Brass P.
        • Hellmich M.
        • Kolodziej L.
        • Schick G.
        • Af S.
        • Patrick B.
        • et al.
        Ultrasound guidance versus anatomical landmarks for internal jugular vein catheterization summary of findings for the main comparison.
        Cochrane Database Syst Rev. 2015; 1: CD006962
        • Lewis T.
        • Merchan C.
        • Altshuler D.
        • Papadopoulos J.
        Safety of the peripheral administration of vasopressor agents.
        J Intensive Care Med. 2019; 34: 26-33
        • Delaney A.
        • Finnis M.
        • Bellomo R.
        • Udy A.
        • Jones D.
        • Keijzers G.
        • et al.
        Initiation of vasopressor infusions via peripheral versus central access in patients with early septic shock: a retrospective cohort study.
        EMA – Emerg Med Australas. 2020; 32: 210-219
        • Delgado T.
        • Wolfe B.
        • Davis G.
        • Ansari S.
        Safety of peripheral administration of phenylephrine in a neurologic intensive care unit: a pilot study.
        J Crit Care [Internet]. 2016; 34 (Available from: https://doi.org/10.1016/j.jcrc.2016.04.004): 107-110
        • Cardenas-Garcia J.
        • Schaub K.F.
        • Belchikov Y.G.
        • Narasimhan M.
        • Koenig S.J.
        • Mayo P.H.
        Safety of peripheral intravenous administration of vasoactive medication.
        J Hosp Med. 2015; 10: 581-585
        • Pancaro C.
        • Shah N.
        • Pasma W.
        • Saager L.
        • Cassidy R.
        • van Klei W.
        • et al.
        Risk of major complications after perioperative norepinephrine infusion through peripheral intravenous lines in a multicenter study.
        Anesth Analg. 2019; (Publish Ah(Xxx)): 1-6
        • Medlej K.
        • Kazzi A.A.
        • El Hajj Chehade A.
        • Saad Eldine M.
        • Chami A.
        • Bachir R.
        • et al.
        Complications from administration of vasopressors through peripheral venous catheters: an observational study.
        J Emerg Med [Internet]. 2018; 54 (Available from: https://doi.org/10.1016/j.jemermed.2017.09.007): 47-53
        • Loubani O.M.
        • Green R.S.
        A systematic review of extravasation and local tissue injury from administration of vasopressors through peripheral intravenous catheters and central venous catheters.
        J Crit Care [Internet]. 2015; 30 (653.e9-653.e17. Available from: https://doi.org/10.1016/j.jcrc.2015.01.014)
        • Bagshaw S.M.
        • Stelfox H.T.
        • McDermid R.C.
        • Rolfson D.B.
        • Tsuyuki R.T.
        • Baig N.
        • et al.
        Association between frailty and short- and long-term outcomes among critically ill patients: a multicentre prospective cohort study.
        CMAJ. 2014; 186: 95-102
        • Beck V.
        • Chateau D.
        • Bryson G.L.
        • Pisipati A.
        • Zanotti S.
        • Parrillo J.E.
        • et al.
        Timing of vasopressor initiation and mortality in septic shock: a cohort study.
        Crit Care. 2014; 18
        • Bai X.
        • Yu W.
        • Ji W.
        • Lin Z.
        • Tan S.
        • Duan K.
        • et al.
        Early versus delayed administration of norepinephrine in patients with septic shock.
        Crit Care. 2014; 18: 1-8
        • De Backer D.
        • Biston P.
        • Devriendt J.
        • Madl C.
        • Chochrad D.
        • Aldecoa C.
        • et al.
        Comparison of dopamine and norepinephrine in the treatment of shock.
        N Engl J Med. 2010; 362: 779-789
        • Ricard J.D.
        • Salomon L.
        • Boyer A.
        • Thiery G.
        • Meybeck A.
        • Roy C.
        • et al.
        Central or peripheral catheters for initial venous access of ICU patients: a randomized controlled trial.
        Crit Care Med. 2013; 41: 2108-2115
        • Tian D.H.
        • Smyth C.
        • Keijzers G.
        • Macdonald S.P.J.
        • Peake S.
        • Udy A.
        • et al.
        Safety of peripheral administration of vasopressor medications: a systematic review.
        EMA – Emerg Med Australas. 2020; 32: 220-227
        • Datar S.
        • Gutierrez E.
        • Schertz A.
        • Vachharajani V.
        Safety of phenylephrine infusion through peripheral intravenous catheter in the neurological intensive care unit.
        J Intensive Care Med. 2018; 33: 589-592