1251: EVALUATION OF THE USE OF PERIPHERAL VASOPRESSORS

Abstract

Introduction: Historically, vasopressors (VP) have been infused via central line to avoid tissue necrosis, but recent studies have suggested that VP may be safely infused via peripheral line (PIV). The guideline at our institution includes procedures on maximum dosing, vein location, catheter gauge, use of a dedicated line, and having two lines meeting these criteria. The primary objective was to determine if our guideline on VP administration via PIV was followed for patients that received single agent VP. The secondary objective was to identify the incidence of extravasation in these patients. Methods: This was a retrospective chart review of adult patients from June to August 2021. Patients were included if they received a single agent catecholamine VP via PIV in an ICU. Results: Sixty patients were included in the analysis. Twenty patients were on the MICU service and 40 were in the SICU. The MICU favored norepinephrine while the SICU favored phenylephrine. Of patients that received single agent VP, 18 (30%) had a central line upon initiation, 29 (48%) had only PIV access, and 13 patients (22%) initially received VP via PIV, but were transitioned to central line. The majority (74%) of patients had at least 1 PIV that met guideline criteria, but only 17 patients (40%) had 2 appropriate PIVs. Nine patients (21%) exceeded the maximum VP dose in the guideline for a median duration of 2.4 hours. Overall, PIV VP administration was deemed appropriate in 13 (31%) patients. During the study period, no patients received phentolamine for VP extravasation, but there have been 3-4 administrations each year in the previous 3 years since the guideline was created. Conclusions: Our guideline for the infusion of VP via PIV was followed in approximately one third of patients receiving single agent VP therapy. Seventy percent of patients receiving single agent VP had only PIV access, and nearly 20% exceeded the maximum VP dose in the guideline with a median of 2 hours. Although no patients required antidote administration for extravasation, since implementation of the guideline there have been 3-4 phentolamine administrations annually. In order to increase guideline adherence, our institution has reinforced the guideline to nurses and providers, and now reviews patients receiving VP via PIV at our daily safety huddle.