(1683) Safety of Peripheral Versus Central Venous Administration of Vasopressors in a Rural Kenyan Hospital

Introduction: Vasopressor infusions are often used in the care of patients in shock. International guidelines recommend that vasopressors are most safely administered through a central venous catheter (CVC) due to concerns of extravasation and local tissue injury. However, this is often not feasible in resource variable settings, due to lack of both material and human resources. Previous studies have assessed the safety of vasopressor infusion through peripheral intravenous catheters (PIVs), but have considered only a small patient population (e.g., pediatric patients) or a short infusion time (e.g., less than 24 hours). Our objective is to describe the incidence of complications in adult and pediatric patients receiving vasopressor infusion via PIV versus CVC in a rural Kenyan hospital.

Methods: This prospective, observational study is being conducted at Kijabe Hospital, a 360-bed tertiary care teaching hospital in rural Kenya. All patients (adult, obstetric, pediatric) receiving intravenous vasopressor infusions who are admitted to the ICU or high-dependency unit (HDU) are included. Consecutive enrollment began in October 2023 and is ongoing. Demographic, physiologic, laboratory, therapeutic, and outcome data are being collected.

Results: Preliminary analysis was performed with 112 patients who were enrolled between October 2023 and May 2024. Median age was 52 years (IQR 31.5-70) and 45% (n=50) were male. Most were adults (n=90, 80.4%), and 22 (19.6%) were children. The overall complication rate was 36.6% (n=41 patients), with all but one complication occurring in patients receiving peripheral vasopressors. The most common complication of peripheral vasopressor use was extravasation/infiltration, (27.7%, n=28), and intervention (surgical debridement) was required in only one case. The sole complication of central vasopressor administration was unplanned line removal, which did not require intervention.

Conclusions: Our preliminary results suggest that the incidence of complications is high in patients receiving vasopressor infusion through a PIV, but complications requiring intervention are rare. Future analyses to assess the frequency of mild, moderate, or severe complications among patients receiving vasopressor infusion via PIV and CVC will be important.