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Do I always need a central venous catheter to administer vasopressors?

Zainab J. Gandhi, MD, Siddharth Dugar, MD, FCCP, FCCM, FASE and Ryota Sato, MD, EDIC
Cleveland Clinic Journal of Medicine May 2024, 91 (5) 287-291; DOI: https://doi.org/10.3949/ccjm.91a.23033

Article Figures & Data

Tables

  • TABLE 1

    Adverse events with peripheral vasopressor administration

    Study typeNumber of patientsVasopressorsDoseaDurationPIVC siteEvents
    Retrospective cohort8202Norepinephrine (72%), phenylephrine (36%)Median initial to maximum: norepinephrine 0.04–0.13, phenylephrine 25–95 μg/minuteMedian 11.5 hours, maximum 19 hoursForearm, antecubital fossa, hand8 events (4%), all local extravasation
    Randomized controlled trial10310 (155 early vasopressor, 155 standard treatment)Norepinephrine (67.7%) and epinephrine (17.4%) in early vasopressor groupMedian (IQR) maximum in early vasopressor group: norepinephrine 0.1 (0.05–0.18), epinephrine 0.41 (0.28–1.2)NRNR6 events in early vasopressor group (3.8%): 1 skin necrosis, 5 acute limb or intestinal ischemia
    Unblinded superiority trial111,563 (782 restrictive fluid, 781 liberal fluid)NRNR9.6 hours in restrictive fluid groupNR3 events in PIVC vasopressor group (n = 500), all 3 were site extravasation
    Prospective cohort1364Epinephrine (66%), norepinephrine (41%)Median (IQR): norepinephrine 0.1 (0.01–0.48), epinephrine 0.12 (0.6–0.38)Median (IQR) 19 hours (8.5–37)Antecubital fossa, forearm, hand2 events (2.9%), extravasation with local tissue swelling
    Randomized controlled trial14263 (128 PIVC, 135 CVC)Epinephrine, norepinephrine< 2 mg/hour, if more, crossover to CVCNRNR133 total events: 56 insertion difficulty, 20 erythema, 19 extravasation, 9 catheter infection
    Prospective cohort15635NorepinephrineMedian (IQR) maximum: 10 μg/minute (6–15)Median (IQR) 5.8 hours (2–20)Antecubital fossa35 extravasationb events (5.5%)
    Retrospective cohort16212 patients (39 PIVC, 155 PIVC followed by CVC, 18 CVC only)Phenylephrine (41%), norepinephrine (38%)Median (IQR) maximum in PIVC-only group: phenylephrine 0.17 (0.09–0.27), norepinephrine 0.99 (0.6–1.64)Median (IQR) 10.5 hours (4.7–15.9) in PIVC-only groupNR75 events (35%): 28 leakage, 25 tissued cannula, 19 extravasation, 2 erythema

    • ↵a Dosing is given as μg/kg/minute except where noted.

    • ↵b Other complications were not reported in this study.

    • CVC = central venous catheter; IQR = interquartile range; NR = not reported; PIVC = peripheral intravenous catheter

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