December 21, 2020

Background:  Vasopressors are usually given through central venous catheters (CVC). This, however, is a time-consuming process and placement of a peripheral venous catheter (PIV) is much faster. Each hour of delay has been associated with a 2% increase in in-hospital mortality.2 Using PIV for the infusion of vasopressors can be an effective alternative for time-sensitive patient care in the emergency department (ED). Previous studies, however, have been inconclusive regarding complications of vasopressor infusion through PIV.

June 4, 2020

Traditionally, vasopressor infusions have been done through central venous catheters (CVCs) due to the hypothetical risk of extravasation injury to extremities when given through peripheral IVs.  The documented risk of extravasation from peripheral pressors is 3 – 6% [1][3][4][5]. Hypothetically, the extravasation rate can be further reduced.  At Essentials of EM 2020 I gave a short 10-minute talk on 6 pearls I have implemented.  This post will serve as a summary of that talk.

February 17, 2020

Background: In REBEL Cast Episode 73, Anand Swaminathan and I discussed two recent studies on the safety of peripheral vasopressors from two large trials [1][2]. An email from good friend Rory Spiegel brought my attention to yet another trial on this topic [3]. I think we can all agree that in patients with septic shock, or shock in general, the administration of vasopressor agents early, can help to stabilize patients and reverse end-organ hypoperfusion.  Traditionally, this has been done through central venous catheters (CVCs) due to the hypothetical risk of extravasation injury to extremities.  The flip side of this is, that central venous catheters are not without their own risks and time to place them can delay a therapy that may benefit patients.

January 2, 2020

Background: Traditionally, vasopressors have been given through central venous catheters (CVCs) in the critically ill.However, the time it takes to place a CVC is time a patient could potentially remain hypotensive. Early initiation of vasopressors may be associated with reduced mortality by increasing end-organ perfusion. Therefore, there has been a growing trend to use vasopressors through peripheral IVs (PIVs).  Running pressors through a peripheral IV has a couple of important benefits including faster time to pressor initiation and no need for invasive procedures (i.e. CVC). There islittle evidence to support the safety of this practice other than one systematic review which included case reports and small case series. Now we have two more papers that evaluate this very question…are peripheral pressors safe?

February 12, 2018

Background: We have discussed the safety of peripheral vasopressors on REBEL EM before. In that review by Loubani et al was a systematic review of 85 articles and 270 patients.  95% of the extravasation events occurred in PIVs with infusions running greater than 4 hours and 85% of extravasation events occurred in PIVs distal to the antecubital fossa.  The major limitation of this systematic review is that the majority of the data was derived from case reports and case series and not prospective trials.  The authors of this current study sought to determine the incidence of complications of running vasopressors through PIVs in patients with circulatory shock in a prospective, observational trial.