Safety of peripheral intravenous administration of vasoactive medication
Publication Date
2015
Journal Title
J Hosp Med
Abstract
BACKGROUNDCentral venous access is commonly performed to administer vasoactive medication. The administration of vasoactive medication via peripheral intravenous access is a potential method of reducing the need for central venous access. The aim of this study was to evaluate the safety of vasoactive medication administered through peripheral intravenous access. METHODSOver a 20-month period starting in September 2012, we monitored the use of vasoactive medication via peripheral intravenous access in an 18-bed medical intensive care unit. Norepinephrine, dopamine, and phenylephrine were all approved for use through peripheral intravenous access. RESULTSA total of 734 patients (age 7215 years, male/female 398/336, SAPS II score 75 +/- 15) received vasoactive medication via peripheral intravenous access 783 times. Vasoactive medication used was norepinephrine (n=506), dopamine (n=101), and phenylephrine (n=176). The duration of vasoactive medication via peripheral intravenous access was 49 +/- 22 hours. Extravasation of the peripheral intravenous access during administration of vasoactive medication occurred in 19 patients (2%) without any tissue injury following treatment, with local phentolamine injection and application of local nitroglycerin paste. There were 95 patients (13%) receiving vasoactive medication through peripheral intravenous access who eventually required central intravenous access. CONCLUSIONSAdministration of norepinephrine, dopamine, or phenylephrine by peripheral intravenous access was feasible and safe in this single-center medical intensive care unit. Extravasation from the peripheral intravenous line was uncommon, and phentolamine with nitroglycerin paste were effective in preventing local ischemic injury. Clinicians should not regard the use of vasoactive medication is an automatic indication for central venous access. Journal of Hospital Medicine 2015;10:581-585. (c) 2015 Society of Hospital Medicine
Volume Number
10
Issue Number
9
Pages
581-585
Document Type
Article
EPub Date
2015/05/28
Status
Faculty, Northwell Researcher
Facility
School of Medicine; Northwell Health
Primary Department
Pulmonary, Critical Care, and Sleep Medicine
PMID
DOI
10.1002/jhm.2394