981: CHANGE IN ATTITUDE FROM CENTRAL TO PERIPHERAL VASOPRESSOR ADMINISTRATION

Abstract

Introduction: Cancer patients have a nearly 10-fold risk of developing sepsis and septic shock compared with patients without cancer. The Surviving Sepsis Campaign guideline recommends prioritizing treatment of low mean arterial pressure (MAP) through vasopressors given peripherally, rather than waiting for placement of a central venous catheter (CVC). Administration of vasopressors through peripheral venous catheters (PVCs) has traditionally been avoided given concerns of extravasation, limb ischemia and tissue necrosis. Studies with safety guidelines when using peripheral vasopressors have been associated with significantly lower prevalence of complications. We sought to evaluate the safety of vasopressor administration through a PVC in a high-risk group of adult oncology patients admitted to our intensive care unit (ICU) and Stepdown Unit (SDU). Methods: Using hospital and ICU databases, we retrospectively analyzed oncology patients admitted to our ICU and SDU from January to December 2021. We then identified patients admitted for septic shock using ICD-10 codes who received a vasopressor agent for > 1 hour via a PVC. Extravasation or other adverse events recorded during or immediately after the peripheral infusion of vasopressor agent were recorded. Results: A total of 1715 patients were admitted to the ICU (n=1097) and SDU (n=618) during the 1-year period. 596 (35%) patients required vasopressors (ICU 491/SDU 105). 165 (28%) of these patients did not have a CVC and received peripheral vasopressors for >1h. 51 of these 165 patients had septic shock. Mean age was 63 years. 77% had solid malignancies. No active extravasation events were noted in all patients administered vasopressors through PVCs. Conclusions: Our study of oncology patients with septic shock demonstrates that administration of vasopressors via PVCs, when given for a limited duration, under close observation, was not associated with extravasation events. Institutional protocols can assist in standardizing the practice for peripheral vasopressor administration and documentation of adverse events.