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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).


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.

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