(1314) Retrospective Review of Peripheral Vasopressor Use and Associated Complications

Introduction: Historically, initiation of vasopressor therapy requires central access, which can result in serious complications and delay reversal of shock; however, peripheral administration has become more widely accepted in recent years. The Surviving Sepsis Campaign now suggests peripheral initiation as a temporizing measure rather than waiting for central line placement. Despite a paucity of high-quality evidence, the benefits of rapid blood pressure restoration and possible avoidance of central line placement generally outweigh the risk of extravasation. Our institution permits peripheral administration of vasopressors at moderate doses for up to 24 hours. Central access is recommended when these parameters are exceeded. This study aims to assess compliance with this policy and evaluate the safety of peripheral vasopressor use to inform potential policy revisions.

Methods: This retrospective review was conducted February 2023-March 2024 and included adult patients initiated on peripheral vasopressors during hospital admission. The primary outcome was the incidence of extravasation events, identified by administration of phentolamine per electronic medication administration record (MAR) documentation. Secondary outcomes include dose and duration of vasopressor therapy and avoidance of central line placement.

Results: A total of 1184 patient encounters with 1775 vasopressor orders linked to a peripheral line were assessed. Median doses (IQR) were 0.11 mcg/kg/min (0.05-0.24) for norepinephrine, 0.2 mcg/kg/min (0.09-0.43) for epinephrine, 0.4 mcg/kg/min (0.2-0.7) for phenylephrine, 0.03 units/min (0.3-0.3) for vasopressin, and 4.5 mcg/kg/min (3-5) for dopamine. Median duration (IQR) was 3.2 hours (0.9-19.5) overall, 10.8 hours for norepinephrine (1.9-35.6), 6.6 hours (1.5-14.3) for epinephrine, 1.1 hours (0.6-2.1) for phenylephrine, 18.5 hours (6.8-39.3) for vasopressin, and 5.4 hours (0.7-16) for dopamine. Extravasation requiring phentolamine occurred in 17 (0.01%) patients.

Conclusions: The rate of extravasation requiring pharmacological intervention was low, occurring in only 0.01% of patients. While retrospective analysis may underestimate the true incidence, our findings support the safety of peripheral vasopressor use and may inform policy revisions pending further analysis.