<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_jccm-2020-0030_s_006_w2aab3b7b7b1b6b1aab1c15b1Aa"><h3>Background</h3><p>Vasopressors are conventionally administered through a central venous catheter (CVC) and not through a peripheral venous catheter (PVC) since the latter is believed to be associated with increased risk of extravasation. Placement of a CVC requires suitably trained personnel to be on hand, and in resource-limited settings, this requirement may delay placement. Because of this and in cases where suitably trained personnel are not immediately available, some clinicians may be prompted to utilise a PVC for infusing vasopressors. The objective of this study is to assess the feasibility and safety of vasopressors administered through a PVC.</p></sec><sec id="j_jccm-2020-0030_s_007_w2aab3b7b7b1b6b1aab1c15b2Aa"><h3>Materials and methods</h3><p>Patients who received vasopressors through a PVC for more than one hour were included in a single centre, consecutive patient observational study. Patients with a CVC at the time of initiation of vasopressors were excluded. Data regarding the size, location of PVCs, dose, duration and number of vasopressors infused were recorded. The decision to place CVC was left to the discretion of the treating physician. Extravasation incidents, severity and management of such events were recorded.</p></sec><sec id="j_jccm-2020-0030_s_008_w2aab3b7b7b1b6b1aab1c15b3Aa"><h3>Results</h3><p>One hundred twenty-two patients age 55(4) years [mean (SD)] were included in the study. The commonest PVC was of 18G calibre (57%), and the most common site of placement was the external jugular vein (36.5%). Noradrenaline was the most common vasopressor used at a dose of 10.6 (7) mcg/min [mean (SD)] and the median duration of nine hours (IQR: 6-14). CVC was placed most commonly due to an increasing dose of vasopressors after 4.5(4) hours [mean (SD)]. Grade 2 Extravasation injury occurred in one patient after prolonged infusion of fifty-two hours, through a small calibre (20G) PVC, which was managed conservatively without any sequelae.</p></sec><sec id="j_jccm-2020-0030_s_009_w2aab3b7b7b1b6b1aab1c15b4Aa"><h3>Conclusion</h3><p>Vasopressors infused through a PVC of 18G or larger calibre into the external jugular, or a forearm vein is feasible and safe. Clinicians need to balance the safety of peripheral vasopressor infusion with the additional costs and complications associated with CVC in resource-limited settings.</p></sec></abstract>

BackgroundVasopressors are conventionally administered through a central venous catheter (CVC) and not through a peripheral venous catheter (PVC) since the latter is believed to be associated with increased risk of extravasation. Placement of a CVC requires suitably trained personnel to be on hand, and in resource-limited settings, this requirement may delay placement. Because of this and in cases where suitably trained personnel are not immediately available, some clinicians may be prompted to utilise a PVC for infusing vasopressors. The objective of this study is to assess the feasibility and safety of vasopressors administered through a PVC.Materials and methodsPatients who received vasopressors through a PVC for more than one hour were included in a single centre, consecutive patient observational study. Patients with a CVC at the time of initiation of vasopressors were excluded. Data regarding the size, location of PVCs, dose, duration and number of vasopressors infused were recorded. The decision to place CVC was left to the discretion of the treating physician. Extravasation incidents, severity and management of such events were recorded.ResultsOne hundred twenty-two patients age 55(4) years [mean (SD)] were included in the study. The commonest PVC was of 18G calibre (57%), and the most common site of placement was the external jugular vein (36.5%). Noradrenaline was the most common vasopressor used at a dose of 10.6 (7) mcg/min [mean (SD)] and the median duration of nine hours (IQR: 6-14). CVC was placed most commonly due to an increasing dose of vasopressors after 4.5(4) hours [mean (SD)]. Grade 2 Extravasation injury occurred in one patient after prolonged infusion of fifty-two hours, through a small calibre (20G) PVC, which was managed conservatively without any sequelae.ConclusionVasopressors infused through a PVC of 18G or larger calibre into the external jugular, or a forearm vein is feasible and safe. Clinicians need to balance the safety of peripheral vasopressor infusion with the additional costs and complications associated with CVC in resource-limited settings.

Feasibility and Safety of Peripheral Intravenous Administration of Vasopressor Agents in Resource-limited Settings

The Journal of Critical Care Medicine

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

BackgroundVasopressors are conventionally administered through a central venous catheter (CVC) and not through a peripheral venous catheter (PVC) since the...

Feasibility and Safety of Peripheral Intravenous Administration of Vasopressor Agents in Resource-limited Settings

Article Category: Research Article

Published Online: Nov 07, 2020

Page range: 210 - 216

Received: Jan 09, 2020

Accepted: Aug 22, 2020

DOI: https://doi.org/10.2478/jccm-2020-0030

Keywords
vasopressors, central venous catheter, peripheral venous catheter, hemodynamic emergencies

© 2020 Ajay Padmanaban, Ramesh Venkataraman, Senthilkumar Rajagopal, Dedeepiya Devaprasad, Nagarajan Ramakrishnan, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Feasibility and Safety of Peripheral Intravenous Administration of Vasopressor Agents in Resource-limited Settings

Article Category: Research Article

Published Online: Nov 07, 2020

Page range: 210 - 216

Received: Jan 09, 2020

Accepted: Aug 22, 2020

DOI: https://doi.org/10.2478/jccm-2020-0030

Keywordsvasopressors, central venous catheter, peripheral venous catheter, hemodynamic emergencies

© 2020 Ajay Padmanaban, Ramesh Venkataraman, Senthilkumar Rajagopal, Dedeepiya Devaprasad, Nagarajan Ramakrishnan, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Keywords
vasopressors, central venous catheter, peripheral venous catheter, hemodynamic emergencies