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Peripheral Pressors – Complications in a Meta-Analysis

December 8, 2020

Written by Meghan Breed

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In this systematic review and meta-analysis, there was a very low prevalence of complications related to vasopressor infusion through a peripheral IV, and using at least a 20-gauge catheter seems to make it safer for patients.

Why does this matter?
Delayed initiation of vasopressors is associated with increased mortality.  In one study of 8,670 patients, each hour of delay was associated with a 2% increase in in-hospital mortality.  If we can safely initiate vasopressor infusion through peripheral venous catheters, we have the opportunity to impact patient care. We reviewed a large retrospective study of peripheral pressors in the past. What’s the consensus?

Can we safely start it?
Nine studies were included in this systematic review and meta-analysis which included a total of 1,835 patients – the clinical setting for two of these studies was exclusively in the ED and exclusively administered through peripheral venous catheters. The seven remaining studies were performed in the ICU setting.  The most common catheter size was a 20-gauge, and the most common vasopressor was norepinephrine. The maximum dose of norepinephrine was 0.13mcg/kg/min.  There were 122 complications in total (7%) – of which 117 (96%) were classified as minor complications (infiltration, erythema) and 5 (4%) were classified as a major complication (peripheral venous thrombosis). However, most studies reported no required treatment for the complication.  Unfortunately, the authors of this study did not identify patient demographics or clinical factors that would potentially predict a higher risk of complications.  Interestingly, the meta-analysis revealed a trend toward much lower rates of complications in studies performed after 2016 (5% complication rate) as opposed to those before 2010 (25% complication rate), likely due to the use of point-of-care ultrasound used to confirm proper placement.  No question – I would start vasopressors peripherally in the ED for shock as opposed to administering more fluid if your patient has been adequately volume resuscitated.

Complication of vasopressor infusion through peripheral venous catheter: A systematic review and meta-analysis. Am J Emerg Med. 2020 Sep 28;S0735-6757(20)30842-1. doi: 10.1016/j.ajem.2020.09.047. Online ahead of print.

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