Comparison of extravasation events related to the peripheral administration of vasopressors prior to and following implementation of an institutional protocol

Abstract

AbstractIntroductionFollowing adequate fluid resuscitation, vasopressors are often utilized to maintain perfusion in shock states. Traditionally, vasopressors are administered via a central venous catheter (CVC) to attempt to minimize extravasation events. New literature advocates for peripheral vasopressor administration when CVC placement could lead to a delay in care. The purpose of this study was to compare extravasation events during vasopressor administration via a peripheral intravenous line (PIV) prior to and following the implementation of an institutional peripheral vasopressor protocol.MethodsThis was a single‐center, retrospective, observational study conducted at a large academic medical center. Adult patients admitted to an intensive care unit (ICU) from September 2018 to 2020 who received continuous infusion vasopressors were included. Vasopressors evaluated were norepinephrine, epinephrine, phenylephrine, dopamine, and vasopressin. The primary outcome evaluated extravasation events prior to and following the implementation of an institutional peripheral vasopressor protocol.ResultsOf the 3430 patients included, 1532 and 1898 patients were in the pre‐ and post‐protocol implementation groups. Following protocol implementation, there was an increase in PIV utilization, improvement in ultrasound‐guided PIV placement (17% vs. 26%, p < 0.001), and line assessment every 2 h (74% vs. 90%, p < 0.001). Less non‐compliance in vasopressor infusion rates (40% vs. 24%, p < 0.001) and PIV location (18% vs. 10%, p < 0.001) were also observed following protocol implementation. A total of 58 extravasation events occurred in both groups, 15 confirmed events and 43 suspected events. Following protocol implementation, there were less extravasation events (2.4% [n = 37] pre‐ vs. 1.1% [n = 21] post‐protocol p = 0.003).ConclusionFollowing the implementation of an institutional protocol, there was a reduction in extravasation events, an improvement in ultrasound‐guided PIV placement, and the use of peripheral infusion practices associated with increased safety. Additional studies are needed to determine the optimal peripheral vasopressor protocol to reduce CVC use and maintain reduced extravasation events.