(1668) Safety of Administration of Vasopressors Through Peripheral Venous Access

Introduction: This study aims to evaluate the rate and complications of extravasation of vasopressor medications when administered through peripheral venous access in critically ill patients. Central venous catheters (CVCs) have been the standard for administration of vasopressor therapy but are associated with complications during placement (pneumothorax, arterial injury) and long-term use (infections, thrombosis). The time to place CVCs has been described as a barrier to early goal-directed therapy in critically ill patients. Recent studies suggest peripheral administration of vasopressors may be safe in short duration, but more data is needed to determine safe vasopressor agents, rates and duration, and PIV size and location. We present a retrospective study aimed at investigating the rate of complication from peripheral vasopressor administration in the critically ill patient.

Methods: We conducted a retrospective review of 386 charts of patients admitted to the ICU at a local community hospital from July 1st, 2021 to December 31st, 2022 who received peripheral vasopressors and did not have central venous access during their ICU admission. The primary end point is rate of extravasation and the secondary end point is associated complications. We also assessed characteristics of IV access, including peripheral IV size and location, and characteristics of vasopressor medication including dose and duration at time of extravasation.

Results: In our study, four extravasation events occurred where all patients received subcutaneous phentolamine without any documented complications of tissue necrosis or limb ischemia. Three vasopressors, Norepinephrine at maximum rate of 35 mcg/min, Vasopressin at 0.04 units/min, and Phenylephrine at maximum rate 200 mcg/min, were involved in the extravasation events. The longest duration of peripheral vasopressor administration prior to extravasation was 32 hours, and the shortest was 13 hours. Peripheral IV access in the extravasation events ranged from sizes 18 to 20 gauge in locations ranging from hand, forearm, and external jugular.

Conclusions: While risk of extravasation remains, patients can safely receive multiple vasopressor medications through peripheral IV access given relatively low rates of extravasation and no complications with administration of phentolamine.