Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 26 , ISSUE 7 ( July, 2022 ) > List of Articles

Original Article

Vasopressor Administration via Peripheral Intravenous Access for Emergency Department Stabilization in Septic Shock Patients

Scott Kilian, Aaron Surrey, Weston McCarron, Kristen Mueller, Brian Todd Wessman

Keywords : Central venous line, Extravasation, Norepinephrine, Peripheral vasopressors, Septic shock

Citation Information : Kilian S, Surrey A, McCarron W, Mueller K, Wessman BT. Vasopressor Administration via Peripheral Intravenous Access for Emergency Department Stabilization in Septic Shock Patients. Indian J Crit Care Med 2022; 26 (7):811-815.

DOI: 10.5005/jp-journals-10071-24243

License: CC BY-NC 4.0

Published Online: 15-07-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Background: Septic shock is commonly treated in the emergency department (ED) with vasopressors. Prior data have shown that vasopressor administration through a peripheral intravenous line (PIV) is feasible. Objectives: To characterize vasopressor administration for patients presenting to an academic ED in septic shock. Materials and methods: Retrospective observational cohort study evaluating initial vasopressor administration for septic shock. ED patients from June 2018 to May 2019 were screened. Exclusion criteria included other shock states, hospital transfers, or heart failure history. Patient demographics, vasopressor data, and length of stay (LOS) were collected. Cases were grouped by initiation site: PIV, ED placed central line (ED-CVL), or tunneled port/indwelling central line (Prior-CVL). Results: Of the 136 patients identified, 69 were included. Vasopressors were initiated via PIV in 49%, ED-CVL in 25%, and prior-CVL in 26%. The time to initiation was 214.8 minutes in PIV and 294.7 minutes in ED-CVL (p = 0.240). Norepinephrine predominated all groups. No extravasation or ischemic complications were identified with PIV vasopressor administration. Twenty-eight-day mortality was 20.6% for PIV, 17.6% for ED-CVL, and 61.1% for prior-CVL. Of 28-day survivors, ICU LOS was 4.44 for PIV and 4.86 for ED-CVL (p = 0.687), while vasopressor days were 2.26 for PIV and 3.14 for ED-CVL (p = 0.050). Conclusion: Vasopressors are being administered via PIVs for ED septic shock patients. Norepinephrine comprised the majority of initial PIV vasopressor administration. There were no documented episodes of extravasation or ischemia. Further studies should look at the duration of PIV administration with potential avoidance of central venous cannulation altogether in appropriate patients.


HTML PDF Share
  1. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 2016;315(8):801–810. DOI: 10.1001/jama.2016.0287.
  2. Gaieski DF, Edwards JM, Kallan MJ, Carr BG. Benchmarking the incidence and mortality of severe sepsis in the United States. Crit Care Med 2013;41(5):1167–1174. DOI: 10.1097/CCM.0b013e31827c09f8.
  3. Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study. Lancet 2020;395(10219):200–211. DOI: 10.1016/S0140-6736(19)32989-7.
  4. Evans L, Rhodes A, Alhazzani A, Antonelli M, Coopersmith CM, French C, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med 2021;49(11):e1063–e1143. DOI: 10.1097/CCM.0000000000005337.
  5. Khan P, Divatia JV. Severe sepsis bundles. Indian J Crit Care Med 2010;14(1):8–13. DOI: 10.4103/0972-5229.63028.
  6. Javeri Y, Jagathkar G, Dixit S, Chaudhary D, Zirpe KG, Mehta Y, et al. Indian society of critical care medicine position statement for central venous catheterization and management 2020. Indian J Crit Care Med 2020;24(Suppl 1):S6–S30. DOI: 10.5005/jp-journals-10071-G23183.
  7. Permpikul C, Tongyoo S, Viarasilpa T, Trainarongsakul T, Chakorn T, Udompanturak S, et al. Early use of norepinephrine in septic shock resuscitation (CENSER): a randomized trial. Am J Respir Crit Care Med 2019;199(9):1097–1105. DOI: 10.1164/rccm.201806-1034OC.
  8. Bai X, Yu W, Ji W, Lin Z, Tan S, Duan K, et al. Early versus delayed administration of norepinephrine in patients with septic shock. Crit Care 2014;18(5):532. DOI: 10.1186/s13054-014-0532-y.
  9. Ospina-Tascon GA, Hernandez G, Alvarez I, Calderon-Tapia LE, Manzano-Nunez R, Sanchez-Ortiz AI, et al. Effects of very early start of norepinephrine in patients with septic shock: a propensity score-based analysis. Crit Care 2020;24(1):52. DOI: 10.1186/s13054- 020-2756-3.
  10. Beck V, Chateau D, Bryson GL, Pisipati A, Zanotti S, Parrillo JE, et al. Timing of vasopressor initiation and mortality in septic shock: a cohort study. Crit Care 2014:18(3):R97. DOI: 10.1186/cc13868.
  11. Greenwalk HP, Gootnick A, Luger NM, et al. Tissue necrosis following subcutaneous infiltration with norepinephrine. N Engl J Med 1952;246:252–253. DOI: 10.1056/NEJM195202142460704.
  12. Humphreys J, Johnston JH, Richardson JC. Skin necrosis following intravenous noradrenaline. BMJ 1955;2(4950):1250–1252. DOI: 10.1136/bmj.2.4950.1250.
  13. Perlow SS, Shapiro RA. Skin necrosis following intravenous use of norepinephrine; report of six cases. Am J Surg 1956;92(4):566–570. DOI: 10.1016/s0002-9610(56)80088-3.
  14. Greenlaw CW, Null LW. Dopamine-induced ischaemia. Lancet 1977;2(8037):555. DOI: 10.1016/s0140-6736(77)90683-3.
  15. Kahn JM, Kress JP, Hall JB. Skin necrosis after extravasation of low-dose vasopressin administered for septic shock. Crit Care Med 2002;30(8):1899–1901. DOI: 10.1097/00003246-200208000-00038.
  16. Dunser MW, Mayr AJ, Tur A, Pajk W, Barbara F, Knotzer H, et al. Ischemic skin lesions as a complication of continuous vasopressin infusion in catecholamine resistant vasodilatory shock: incidence and risk factors. Crit Care Med 2003;31(5):1394–1398. DOI: 10.1097/01.CCM.0000059722.94182.79.
  17. Bunker N, Higgins D. Peripheral administration of vasopressin for catecholamine-resistant hypotension complicated by skin necrosis. Crit Care Med 2006;34(3):935. DOI: 10.1097/01.CCM.0000202202.85087.37.
  18. Alexander CM, Ramseyer M, Beatty JS. Missed extravasation injury from peripheral infusion of norepinephrine resulting in forearm compartment syndrome and amputation. Am Surg 2016;82(7): e162–e163. PMID: 27457846.
  19. Ablordeppey EA, Drewry AM, Beyer AB, Theodoro DL, Fowler SA, Fuller BM, et al. Diagnostic accuracy of central venous catheter confirmation by bedside ultrasound versus chest radiography in critically ill patients: a systematic review and meta-analysis. Crit Care Med 2017;45(4):715–724. DOI: 10.1097/CCM.0000000000002188.
  20. Delgado T, Wolfe B, Davis G, Ansari S. Safety of peripheral administration of phenylephrine in a neurologic intensive care unit: a pilot study. J Crit Care 2016;34:107–110. DOI: 10.1016/j.jcrc.2016.04.004.
  21. 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–e17. DOI: 10.1016/j.jcrc.2015.01.014.
  22. Cardenas-Garcia J, Schaub KF, Belchikov YG, Narasimhan M, Koenig SJ, Mayo PH. Safety of peripheral intravenous administration of vasopressors through peripheral intravenous catheters and central venous catheters. J Hosp Med 2015;10(9):581–585. DOI: 10.1002/jhm.2394.
  23. 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.
  24. Datar S, Gutierrez E, Schertz A, Vachharajani V. Safety of phenylephrine infusion through peripheral intravenous catheter in the neurological intensive care unit. J Intensive Care Med 2018;33(10):589–592. DOI: 10.1177/0885066617712214.
  25. Ballieu P, Besharatian Y, Ansari S. Safety and feasibility of phenylephrine administration through a peripheral intravenous catheter in the neurocritical care unit. J Intensive Care Med 2021;36(1):101–106. DOI: 10.1177/0885066619887111.
  26. Pancaro C, Shah N, Pasma W, Saager L, Cassidy R, van Klei W, et al. Risk of major complication after perioperative norepinephrine infusion through peripheral intravenous lines in a multicenter study. Anesth Analg 2020;131(4):1060–1065. DOI: 10.1213/ANE.0000000000004445.
  27. Padmanaban A, Venkataraman R, Rajagopal S, Devaprasad D, Ramakrishnan N. Feasibility and safety of peripheral intravenous administration of vasopressor agents in resource-limited settings. J Crit Care Med 2020;6(4):210–216. DOI: 10.2478/jccm-2020-0030.
  28. Medlej K, Kazzi AA, Chehade AEH, Eldine MS, Chami A, Bachir R, et al. Complications from administration of vasopressors through peripheral venous catheters-an observational study. J Emerg Med 2018;54(1):47–53. DOI: 10.1016/j.jemermed.2017.09.007.
  29. Nguyen TT, Surrey A, Barmaan B, Miller S, Oswalt A, Evans D, et al. Utilization and extravasation of peripheral norepinephrine in the emergency department. Am J Emerg Med 2021;39:55–59. DOI: 10.1016/j.ajem.2020.01.014.
  30. Tran QK, Mester G, Bzhilyanskaya V, Afridi LZ, Andhavarapu S, Alam Z, et al. Complication of vasopressor infusion through peripheral venous catheter: a systematic review and meta-analysis. Am J Emerg Med 2020;38(11):2434–2443. DOI: 10.1016/j.ajem.2020.09.047.
  31. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign guidelines committee including the pediatric subgroup surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2021. Crit Care Med 2013;41(2):580–637. DOI: 10.1097/CCM.0b013e31827e83af.
  32. Herget-Rosenthal S, Saner F, Chawla LS. Approach to hemodynamic shock and vasopressors. CJASN 2008;3(2):546–553. DOI: 10.2215/CJN.01820407.
  33. Hollenberg SM, Ahrens TS, Annane D, Astiz ME, Chalfin DB, Dasta JF, et al. Practice parameters for hemodynamic support of sepsis in adult patients: 2004 update. Crit Care Med 2004;32(9):1928–1948. DOI: 10.1097/01.ccm.0000139761.05492.d6.
  34. Vincent J-L, Jones G, David S, Olariu E, Cadwell KK, et al. Frequency and mortality of septic shock in Europe and North America: a systematic review and meta-analysis. Crit Care 2019;23(1):196. DOI: 10.1186/s13054-019-2478-6.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.