AN INITIATIVE TO REDUCE CENTRAL LINE DAYS BY IMPLEMENTING PERIPHERAL ADMINISTRATION OF VASOPRESSORS IN A VA MEDICAL ICU

Abstract

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: The use of central venous catheters (CVCs) remains standard of care for delivering vasopressors in patients with shock though it is associated with mechanical and infectious complications. In an initiative to reduce central line days, a multi-disciplinary team devised a protocol for the administration of vasopressors via peripheral IV (PIV). In February 2019, the protocol was implemented in the 9-bed medical intensive care unit (MICU) of the Michael E. DeBakey VA Medical Center (MEDVAMC), a 349-bed teaching hospital. We hypothesized that central line days would be reduced with initiation of this protocol. METHODS: A retrospective chart review was conducted on all veterans in the MICU that received vasopressors peripherally at the MEDVAMC between Feb 1st, 2019 till October 26th, 2019. The primary end point evaluated was central line days. Additional data collected included PIV site, vasopressor medication choice, duration and dosage, as well as escalation from PIV to central venous catheter (CVC). Extravasation events were monitored. RESULTS: Of the 46 patients that met the inclusion criteria for peripheral vasopressor use, 93% were male and the mean age of the study participants was 66 years of age. Eighty-three percent of patients (n=38) had peripheral IV placement in the forearm or upper arm with the remainder having vascular access through the external jugular, antecubital and wrist veins. The majority of the patients received norepinephrine (n=43, 94%) with an average dose of 12 mcg/min (range of 2-40 mcg/min). The remaining patients received epinephrine (n=1, 2%), dopamine (n=1, 2%) and phenylephrine (n=1, 2%). The average duration of vasopressors was 24.06 hours with 35% of patients (n=16) receiving peripheral vasopressors for greater than one day. CVC placement was required in nine patients (20%); five of those patients required escalation to CVC due to requirement for multiple vasopressors. There were no extravasation events associated with peripheral administration of vasopressors. The total number of CVC days from February through September of 2018 and 2019 were 526 and 408, respectively. CONCLUSIONS: Central line days were reduced by 22% when comparing an eight-month period of time to historical control. There were no adverse events related to peripheral administration of vasopressors. Further research is required over a longer period to quantify trends in central line days as well as impact on patient outcomes including mortality. CLINICAL IMPLICATIONS: Prior literature supports the safety of peripheral vasopressor administration in settings where there are established protocols and education of all providers. Our work demonstrates that implementation of such a protocol can significantly reduce central line days and still maintain patient safety in a VA Medical Intensive Care Unit. DISCLOSURES: No relevant relationships by Uma Ayyala, source=Web Response No relevant relationships by Stephanie Bird, source=Web Response No relevant relationships by Mary George, source=Admin input no disclosure on file for Charlie Lan; No relevant relationships by Nathan Nowalk, source=Web Response No relevant relationships by June Pickett, source=Web Response No relevant relationships by Shazia Raheem, source=Web Response no disclosure on file for Felix Rouse