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Chapter 5

Lit Matters: Peripheral Pressors are your Frenemy

Matt Delaney, MD and Salim Rezaie, MD
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Peripheral pressors were once persona non grata in the resus room, but that has changed over the past few years as mounting evidence has purported their safety. But are they as safe as we've been led to believe?

 

  • Lit Matters #2: Tian DH, et al. Safety of peripheral administration of vasopressor medications: A systematic review. Emerg Med Australas. 2019 Nov 7. PMID: 31698544.

    • Bottom line:  Use of a peripheral IV (PiVC) for vasopressor infusion is unlikely to result in extravasation or major complications, provided that guidelines are followed to ensure safety.

    • Methods: This systematic review aimed to determine if it is safe to administer vasopressors through a peripheral IV.  

    • Results: 7 studies and 1382 patients were included.  The mean duration of infusion was 22 hours. Extravasation occurred in 3.4% of patients and all were managed conservatively with no cases of tissue necrosis.

    • Editors’ tips for using PiVCs safely: 

      • Select an antecubital fossa or more proximal vein. These larger veins allow for bigger IV access and are less likely to push the needle through the back wall of the vessel.

      • Choose the longest catheter possible as this may decrease the chance of extravasation.

      • Try to limit  infusions to under 2 - 4hrs.

      • Use as dilute a concentration and yet as small a volume as possible.

      • Have an IV observation protocol.  Someone should check the IV every 15-20 min.

      • Have an extravasation protocol.

Additional references:

  1.  Loubani OM et al. A systematic review of extravasation and local tissue injury from administration of vasopressors through peripheral intravenous catheters and central venous catheters. J Crit Care 2015. PMID: 25669592

  2. Pancaro C et al. Risk of Major Complications After Perioperative Norepinephrine Infusion Through Peripheral Intravenous Lines in a Multicenter Study. Anesth Analg 2019. PMID: 31569163

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2.25 AMA PRA Category 1 Credits™ certified by Hippo Education (2020)