Safety of peripheral administration of vasopressor medications: A systematic review

作者：David H. Tian, Claire Smyth, Gerben Keijzers, Stephen P J Macdonald, Sandra Peake, Andrew Alexander Udy, Anthony P. Delaney · 发表于：Emergency Medicine Australasia · 年份：2019 · DOI：10.1111/1742-6723.13406 · 被引用次数：162 · 研究领域：Central Venous Catheters and Hemodialysis、Chemotherapy-related skin toxicity、Acute Kidney Injury Research

OBJECTIVE: Vasopressor medications have traditionally been administered via central venous catheters (CVCs), primarily due to concerns of peripheral extravasation of vasoconstrictive medications. Recent studies have suggested that vasopressor administration via peripheral intravenous catheters (PiVCs) may be a feasible and safe alternative. This systematic review evaluates the safety of delivering vasopressor medications via PiVCs. METHODS: We performed a systematic review to assess the frequency of complications associated with the delivery of vasopressors via PiVCs. A literature search for prospective and retrospective studies of vasopressor infusions in adults was performed. We included studies of continuous infusions of vasopressor medications (noradrenaline, adrenaline, metaraminol, phenylephrine, dopamine and vasopressin) delivered via a PiVCs that included at least 20 patients. Data on patient factors, cannulation approach, monitoring protocols, vasopressor dosing and dilutions and adverse events were collected and summarised. RESULTS: Seven studies were identified that fulfilled the inclusion criteria, including 1382 patients. No study fulfilled all of the validity criteria. Noradrenaline was the most commonly administered agent (n = 702 episodes of administration), followed by phenylephrine (n = 546), dopamine (n = 108), metaraminol (n = 74) and vasopressin and adrenaline (<5 patients). Mean duration of infusion was 22 h (95% confidence interval [CI] 8-36 h). Extrava...