Safety of peripheral administration of phenylephrine in a neurologic intensive care unit: A pilot study

Delgado, Tim; Wolfe, Brianne M; Davis, George K.; Ansari, Safdar

doi:10.1016/j.jcrc.2016.04.004

Cited by 34 publications

(37 citation statements)

References 30 publications

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“…The literature search identified 5074 records, of which seven studies fulfilled the inclusion/exclusion criteria . The reasons for exclusion are shown in Figure .…”

Section: Resultsmentioning

confidence: 99%

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Safety of peripheral administration of vasopressor medications: A systematic review

Tian

Smyth

Keijzers

et al. 2019

Emerg Medicine Australasia

111

109

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Objective Vasopressor medications have traditionally been administered via central venous catheters (CVCs), primarily due to concerns of peripheral extravasation of vasoconstrictive medications. Recent studies have suggested that vasopressor administration via peripheral intravenous catheters (PiVCs) may be a feasible and safe alternative. This systematic review evaluates the safety of delivering vasopressor medications via PiVCs. Methods We performed a systematic review to assess the frequency of complications associated with the delivery of vasopressors via PiVCs. A literature search for prospective and retrospective studies of vasopressor infusions in adults was performed. We included studies of continuous infusions of vasopressor medications (noradrenaline, adrenaline, metaraminol, phenylephrine, dopamine and vasopressin) delivered via a PiVCs that included at least 20 patients. Data on patient factors, cannulation approach, monitoring protocols, vasopressor dosing and dilutions and adverse events were collected and summarised. Results Seven studies were identified that fulfilled the inclusion criteria, including 1382 patients. No study fulfilled all of the validity criteria. Noradrenaline was the most commonly administered agent (n = 702 episodes of administration), followed by phenylephrine (n = 546), dopamine (n = 108), metaraminol (n = 74) and vasopressin and adrenaline (<5 patients). Mean duration of infusion was 22 h (95% confidence interval [CI] 8–36 h). Extravasation occurred in 3.4% (95% CI 2.5–4.7%) of patients. There were no reported episodes of tissue necrosis or limb ischaemia. All extravasation events were successfully managed conservatively or with vasodilatory medications. Conclusions Reports of the administration of vasopressors via PiVCs, when given for a limited duration, under close observation, suggest that extravasation is uncommon and is unlikely to lead to major complications.

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“…The literature search identified 5074 records, of which seven studies fulfilled the inclusion/exclusion criteria . The reasons for exclusion are shown in Figure .…”

Section: Resultsmentioning

confidence: 99%

“…The literature search identified 5074 records, of which seven studies fulfilled the inclusion/exclusion criteria. 10,11,[15][16][17][18][19] The reasons for exclusion are shown in Figure 1. Agreement on the inclusion of studies was reached without the need for a third reviewer.…”

Section: Literature Searchmentioning

confidence: 99%

Safety of peripheral administration of vasopressor medications: A systematic review

Tian

Smyth

Keijzers

et al. 2019

Emerg Medicine Australasia

111

109

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“…[10] In a 6-month pilot study, phenylephrine was administered via PIV access in 20 patients with one minor complication and no major injuries. [11] This was achieved by implementing safety measures in the computerized physician order entry system (CPOE) and by utilizing nurse-driven protocols. This study concluded that with careful monitoring and safety protocols, peripheral administration of vasopressors may be acceptable.…”

Section: Review Of the Literaturementioning

confidence: 99%

“…This study concluded that with careful monitoring and safety protocols, peripheral administration of vasopressors may be acceptable. [11] A systematic review of the literature conducted by Loubani and Green [12] determined that vasopressors can cause tissue damage and limb injury when given via PIV access. Case reports demonstrated that administration of vasopressors greater than 2 hours and placement of the PIV catheter distal to the antecubital fossa were more likely to cause local tissue injury.…”

Section: Review Of the Literaturementioning

confidence: 99%

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

Padrone

Galiczewski

Amitrano

et al. 2018

IJH

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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.

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“…However, like with any intervention that has the potential for harm, we must be judicious with the use of CVCs and recognize that minimizing their use is potentially an effective way to reduce CRBSI. Although there is a paucity of clinical trial data [13], an increasing body of observational literature is challenging dogma and questioning the necessity for routine CVC insertion for "classical" indications such as lower dose vasopressor infusion [14][15][16][17].…”

mentioning

confidence: 99%

The CVC and CRBSI: don’t use it and lose it!

2017

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Safety of peripheral administration of phenylephrine in a neurologic intensive care unit: A pilot study

Cited by 34 publications

References 30 publications

Safety of peripheral administration of vasopressor medications: A systematic review

Safety of peripheral administration of vasopressor medications: A systematic review

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

The CVC and CRBSI: don’t use it and lose it!

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