Safety of peripheral administration of vasopressor medications: A systematic review

David H Tian; Claire Smyth; Gerben Keijzers; Stephen Pj Macdonald; Sandra Peake; Andrew Udy; Anthony Delaney

doi:10.1111/1742-6723.13406

Safety of peripheral administration of vasopressor medications: A systematic review

Emerg Med Australas. 2020 Apr;32(2):220-227. doi: 10.1111/1742-6723.13406. Epub 2019 Nov 7.

Authors

David H Tian¹, Claire Smyth¹, Gerben Keijzers^{2

3

4}, Stephen Pj Macdonald^{5

6}, Sandra Peake^{7

8

9}, Andrew Udy^{8

10}, Anthony Delaney^{1

8

11

12}

Affiliations

¹ Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia.
² Emergency Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia.
³ School of Medicine, Bond University, Gold Coast, Queensland, Australia.
⁴ School of Medicine, Griffith University, Gold Coast, Queensland, Australia.
⁵ Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia.
⁶ Emergency Department, Royal Perth Hospital, The University of Western Australia, Perth, Western Australia, Australia.
⁷ Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
⁸ Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
⁹ School of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.
¹⁰ Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.
¹¹ Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
¹² Division of Critical Care, The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia.

PMID: 31698544
DOI: 10.1111/1742-6723.13406

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.

Keywords: central venous access; extravasation; infusion; peripheral access; tissue injury; vasopressors.

Publication types

Systematic Review

MeSH terms

Adult
Catheterization, Peripheral* / adverse effects
Humans
Hypotension*
Prospective Studies
Retrospective Studies
Vasoconstrictor Agents / adverse effects

Substances

Vasoconstrictor Agents