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

Abstract

Objective To assess whether the initiation of vasopressor infusions via peripheral venous catheters (PVC) compared to central venous catheters (CVC) in ED patients with early septic shock was associated with differences in processes of care and outcomes. Methods We conducted a post‐hoc analysis of the ARISE trial. We compared participants who had a vasopressor infusion first commenced via a PVC versus a CVC. The primary outcome was 90 day mortality. Results We studied 937 participants. Of these, 389 (42%) had early vasopressor infusion commenced via a PVC and 548 (58%) via a CVC. Trial participants who received a vasopressor infusion via a PVC were more severely ill, with higher median (interquartile range [IQR]) Acute Physiology And Chronic Health Evaluation (APACHE II) scores (17 [13–23] versus 16 [12–21], P = 0.003), and higher median (IQR) lactate (mmol/L) (3.6 [1.9–5.8] versus 2.5 [1.5–4.5], P < 0.001). After adjusting for baseline covariates, the estimated odds ratio for mortality for PVC‐treated patients was 1.26 (95% confidence interval 0.95–1.67, P = 0.11). Trial participants who had vasopressors commenced via PVC had a shorter median (IQR) time to commencement of antimicrobials (55 [32–96] versus 71.5 [39–119] min, P < 0.001) and a shorter median (IQR) time to commencement of vasopressors (2.4 [1.3–3.9] versus 4.9 [3.5–6.6] h, P < 0.001). Conclusion The practice of commencing a vasopressor infusion via a PVC was common in the ARISE trial and more frequent in trial participants with higher severity of illness. Commencement of a vasopressor infusion via a PVC was associated with some improvements in processes of care and, after adjustment, was not associated with an increased risk of death.

Early Care of Adults With Suspected Sepsis in the Emergency Department and Out-of-Hospital Environment: A Consensus-Based Task Force Report

“…Current limited data suggest that early administration of peripheral norepinephrine through large-bore peripheral intravenous catheters for short intervals with appropriate monitoring is safe during resuscitation. [94][95][96][97][98] Antimicrobials Key Points:…”

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).…”

A prospective comparison of peripheral metaraminol versus dilute noradrenaline in the intensive care unit

“…In Australia and New Zealand, metaraminol is frequently used as a peripheral vasopressor, but noradrenaline can also be administered in a dilute solution peripherally. 2,3 We conducted a prospective observational study aiming to compare the safety and cost of peripheral noradrenaline infusion compared with metaraminol infusion for patients requiring low dose vasopressor support in our tertiary 30 bed intensive care department.…”

“…A prospective comparison of peripheral metaraminol versus dilute noradrenaline in the intensive care unit Vera EW Ruchti 1 , Bradley A Wibrow 1,2 , Jason Seet 1 , Angela Jacques 3,4 , Nihar Jha 1 and Matthew H Anstey 1,2,5 Background Haemodynamic support using vasopressors is a common intervention provided to patients in the intensive care unit (ICU). Traditionally, they have been administered by way of a central venous line (CVC) to ensure prompt delivery and avoid potential complications that may occur with extravasation from a peripheral site.…”