Feasibility and Safety of Peripheral Intravenous Administration of Vasopressor Agents in Resource-limited Settings

Abstract

BackgroundVasopressors are conventionally administered through a central venous catheter (CVC) and not through a peripheral venous catheter (PVC) since the latter is believed to be associated with increased risk of extravasation. Placement of a CVC requires suitably trained personnel to be on hand, and in resource-limited settings, this requirement may delay placement. Because of this and in cases where suitably trained personnel are not immediately available, some clinicians may be prompted to utilise a PVC for infusing vasopressors. The objective of this study is to assess the feasibility and safety of vasopressors administered through a PVC.Materials and methodsPatients who received vasopressors through a PVC for more than one hour were included in a single centre, consecutive patient observational study. Patients with a CVC at the time of initiation of vasopressors were excluded. Data regarding the size, location of PVCs, dose, duration and number of vasopressors infused were recorded. The decision to place CVC was left to the discretion of the treating physician. Extravasation incidents, severity and management of such events were recorded.ResultsOne hundred twenty-two patients age 55(4) years [mean (SD)] were included in the study. The commonest PVC was of 18G calibre (57%), and the most common site of placement was the external jugular vein (36.5%). Noradrenaline was the most common vasopressor used at a dose of 10.6 (7) mcg/min [mean (SD)] and the median duration of nine hours (IQR: 6-14). CVC was placed most commonly due to an increasing dose of vasopressors after 4.5(4) hours [mean (SD)]. Grade 2 Extravasation injury occurred in one patient after prolonged infusion of fifty-two hours, through a small calibre (20G) PVC, which was managed conservatively without any sequelae.ConclusionVasopressors infused through a PVC of 18G or larger calibre into the external jugular, or a forearm vein is feasible and safe. Clinicians need to balance the safety of peripheral vasopressor infusion with the additional costs and complications associated with CVC in resource-limited settings.

Vasopressor Administration via Peripheral Intravenous Access for Emergency Department Stabilization in Septic Shock Patients

“…A growing body of evidence from predominately intensive care unit (ICU) and operating room (OR-)-based studies suggests that vasopressors can be administered through a PIV with low rates of extravasation or injury. 20 – 27 These findings were recently replicated in ED- based studies and in a meta-analysis. 28 – 30 However, as this practice remains a conditional recommendation in the recent 2021 Surviving Sepsis Guidelines, 4 there is a need for additional investigation regarding peripheral administration for patients in the ED, specifically with septic shock.…”

Prediction of extended period of vasopressor infusion requiring central venous catheterisation: A burning issue in critical care

“…A burning issue in critical care Zhongheng Zhang 1,2 , Leo A Celi 3,4,5 and Kwok M Ho 6,7,8 Vasopressor infusion is one of the most important interventions in the critical care setting, especially for patients with circulatory failure. 1 While vasopressors can help to elevate arterial blood pressure and maintain adequate tissue perfusion, prolonged use of vasopressors is associated with non-trivial complications, including cardiac arrhythmia, peripheral organ ischaemia, and a requirement for a central venous catheter (CVC).…”

“…There has been accumulating evidence showing that infusing vasopressors through a peripheral venous catheter (PVC), at least in a diluted form, is both feasible and safe. [3][4][5][6] Infusing vasopressors via a PVC for a short period of time is helpful to avoid CVC placement. Therefore, it is important to identify risk factors for extended vasopressor infusion, and to predict who will need prolonged use of vasopressors as early as possible.…”