(1404) Vasopressor Administration Through Peripheral Venous Catheters and Risk Factors for Extravasation

Introduction: Vasopressors have historically been administered via central access due to risks of extravasation and tissue damage. There is sparse but accumulating data to support peripheral administration of vasopressors at low infusion rates to avoid risks of central line procedure complications and avoid delay in treatment. The goal of this study is to evaluate extravasation risk associated with varying approaches to vasopressor administration.

Methods: A retrospective, observational, single center study was conducted at an academic-community hybrid medical center from October 2022 to September 2023. Adult patients were included if they received dopamine, epinephrine, norepinephrine, phenylephrine, or vasopressin through a peripheral venous catheter (PVC) for more than one hour.

Results: A total of 102 patients were included in the analysis. Majority of patients received a single vasopressor (62.7%) followed by two vasopressors (19.6%), through an 18-gauge PVC (75.5%) located antecubital or above (61.8%) for a median duration of 13.2 (4.9–25.1) hours. Dopamine was administered to 7 patients (6.9%), epinephrine 19 (18.6%), norepinephrine 93 (91.2%), phenylephrine 6 (5.9%), and vasopressin 34 (33.3%). A total of 38 (37.3%) patients required a central venous catheter, resulting in a median of one central line day avoided per patient (IQR 1-1). There were 28 patients (27.5%) with a documented extravasation event that occurred a median of 17.6 hours (IQR 7.5-39.1) after vasopressor administration. Phentolamine was administered in 3 patients (2.9%) and no surgical consults were required in any patient (0%). A logistic regression was performed and showed no association with extravasation events and a norepinephrine infusion rate > 15 mcg/min, multiple vasopressors, or PVC location. However, vasopressor duration greater than 24 hours, smaller than an 18-gauge catheter, and ultrasound guided PVC administration were associated with an increased likelihood of an extravasation event.

Conclusions: Peripheral administration of vasopressors resulted in numerous extravasation events; however, there was minimal medication intervention and no surgical necessity. Longer PVC vasopressor infusion duration, smaller gauge catheters, and ultrasound guidance were associated with increased risk of extravasation.