Contributor: Aaron Lessen, MD

Educational Pearls:

• Traditional teaching has shied away from using vasopressors through peripheral IVs
• Tissue necrosis from extravasation is cited as a risk of use of vasopressors through a peripheral site
• However, risk of extravasation is low (2-4%) and even more rarely results in significant complications
• Using an IV that is more proximal and larger bore with monitoring can further minimize these risks
• Starting with peripheral vasopressors in a critically ill patient appears to be without significant increased cutaneous complications compared to using a central line alone

References

Loubani OM, Green RS. A systematic review of extravasation and local tissue injury from administration of vasopressors through peripheral intravenous catheters and central venous catheters. J Crit Care. 2015;30(3):653.e9-653.e6.53E17. doi:10.1016/j.jcrc.2015.01.014

Cardenas-Garcia J, Schaub KF, Belchikov YG, Narasimhan M, Koenig SJ, Mayo PH. Safety of peripheral intravenous administration of vasoactive medication. J Hosp Med. 2015;10(9):581-585. doi:10.1002/jhm.2394

Lewis T, Merchan C, Altshuler D, Papadopoulos J. Safety of the Peripheral Administration of Vasopressor Agents. J Intensive Care Med. 2019;34(1):26-33. doi:10.1177/0885066616686035

Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD