Introduction: Vasopressors are traditionally administered via the central venous catheter (CVC) due to the concerns of extravasation and tissue injury. Catecholamine vasopressor administration via the peripheral venous catheter (PVC) has been shown safe. The PVC facilitates early vasopressor application and reduces the CVC complications such as infection, thrombosis, bleeding or pneumothorax. Data regarding the safety of vasopressin administration via the PVC is limited. Vasopressin has an intermediate to high vesicant risk due to low pH/ high osmolarity/vasoconstrictive properties and lacks specific antidote upon extravasation. This review assesses the safety of vasopressin administered via the PVC in critically ill patients and reduction in the CVC days.
Methods: Retrospective analysis at an academic medical center via the electronic medical record and adverse event reporting system review. Inclusion- Adult patients under the medical intensive care unit (MICU) from 4/1/24 to 11/30/24 receiving vasopressin infusion via the PVC. Data collected include extravasation events, CVC days avoided, patient demographics, mortality/ ICU length of stay (LOS), PVC size/location & vasopressin dose/duration. Exclusion- Patients receiving vasopressin infusion via only the CVC.
Results: A total of 101 (63%) patients were analyzed who received vasopressin via the PVC. One patient (0.9%) experienced extravasation (swelling/blistering) also had norepinephrine running through the same PVC. Total CVC avoidance days were 62. Median patient age was 57 years (males-58%). Primary diagnosis was shock with a median ICU LOS of 6 days. Mean vasopressin duration per patient was 14 hours (concentration 0.4 unit/ml & rate 0.03 unit/min) and 15 % of the patients received it peripherally for 24 hours or more. Maximal vasopressin peripheral infusion duration was 7 days. 16 % of the patients never required a CVC (44 % discharged alive & 25 % transferred to hospice). Most common PVC insertion site was forearm with 20 G or less.
Conclusions: This study provides evidence for the safe administration of vasopressin via the PVC which is lacking in the published literature and shows considerable reduction in the CVC days. Future prospective randomized studies are needed to assess the true impact of the peripherally administered vasopressin.
