(1041) NEP SCORE: A Tool for Targeting Peripheral Norepinephrine Utilization

Introduction: Norepinephrine (NE) is a known vesicant and is potentially dangerous in cases of line extravasation which has led to a presumption of urgent need for central line insertion upon treatment initiation. Recent publications suggest immediate intervention may not be required and that delaying central line insertions could have beneficial effects by reducing total days of central line exposure. Our purpose was to identify patient attributes to form a scoring tool which might be predictive of central line avoidance in NE patients.

Methods: This was an IRB approved, retrospective, system-wide study that included adults greater than 17 years old receiving NE within 6 hours of admission between January 1, 2021, and December 31, 2022. The study excluded patients with established central IV access, those requiring a second vasopressor within 6 hours of arrival, or those who expired within 48 hours. Probability of success of extended peripheral NE usage was calculated using the inverse of the total exposure time to NE plus the absence of alternative indications for central line insertion. The primary outcome was to identify the correlation between variables and the probability of success. Statistical analysis was performed using R software and the coefficient of determination (R2) was obtained.

Results: Of 10,160 identified patients, a random subsample of 1,016 patients was selected for further data collection. The average age was 65 years and 57.7% of patients were male. Eight variables demonstrated an association with calculated probability of success, including maximum serum lactate, total bilirubin, white blood cell count, serum creatinine, change in heart rate (HR), average HR, baseline mean arterial pressure (MAP), and early response MAP (MAP after first 6 hours of NE). Although these were independently associated with probability of success, backwards stepwise linear regression analysis failed to produce a robust predictive tool which could be clinically useful and further analysis was abandoned.

Conclusions: No single variable or group of variables was well predictive of central line avoidance in early NE treatment. Data did not support the formation of a simplified scoring tool to identify an association between baseline characteristics and successful peripheral NE use.