Safety of peripheral administration of vasopressor medications: A systematic review

Abstract

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.

Identifying Perioperative Anesthetic Factors associated with Postoperative Morbidity in Robot-Assisted vs. Open Pancreatoduodenectomy: A Cohort Study

“…Although the intraoperative use of vasopressors was evident, we feel supported by recently published data that routinely insertion of a central venous catheter is not mandatory in RAPD or OPD patients [19,20]. surgery hyperlactatemia and development of postoperative pancreatic stula [24].…”

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

“…In line with other authors, our study demonstrates that the peripheral intravenous administration of vasopressors carries a low rate of complications and offers a substitute to administration through a central venous line. 2,[4][5][6] To support the safe administration we instituted the following measures: development of a guideline in conjunction with pharmacy, education of staff, nursing staff ratios allowing careful titration of doses and observation for complications, and strict use of an appropriately running peripheral cannula. We also had a limit at which clinicians were encouraged to switch to the central administration of vasopressors, (metaraminol rate >5 mg/hour, or 600 lg/hour of noradrenaline).…”

“…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.…”

Controversies in Sepsis Management—What is the Way Forward?

“…The technicalities of having to administer higher doses of vasopressors through a central venous line may limit its use, but a recent systemic review suggested low dose noradrenaline, dopamine, phenylephrine can safely be given peripherally. 34 The current evidence recommends a haemodynamically-guided conservative fluid resuscitation strategy with early recognition of vasopressor initiation.…”