Successful Implementation of Peripheral Vasopressor Policy and Use

Introduction: Vasopressors are recommended for central line administration due to the risk of infiltration and extravasation with peripheral lines. However, central line placement is invasive and has its own risks.This type of invasive procedure may not align with all patients’ goals of care. Newer data suggests that short-term vasopressor use through a peripheral line under close monitoring is a safe alternative to central line placement. To facilitate appropriate use, a hospital policy was developed allowing for peripheral vasopressor administration use up to 24 hours provided the IV site was assessed every 2 hours.


Methods: A single-center, retrospective analysis of peripheral vasopressor use was conducted from September 2023-March 2024 after the implementation of a peripheral vasopressor policy. Adult patients were included if they were admitted to the emergency department or intensive care unit and had received a policy approved peripheral infusion vasopressor: norepinephrine, dopamine or phenylephrine. Incidence of infiltration or extravasation events were identified through the institutions incidence reporting system and chart review was conducted to corroborate.


Results: There were a total of 2722 norepinephrine, 204 dopamine and 401 phenylephrine medication orders. Of these, 23.9% of norepinephrine, 14.4% of dopamine and 31.4% of phenylephrine orders were run peripherally for a period of time. The median duration of peripheral administration was 3 (1-76) hours for norepinephrine and 2 (1-24) hours for dopamine and 2 (1-39) hours for phenylephrine. For those patients who received the vasopressor peripherally initially, the order was stopped and a central line was not pursued for norepinephrine, dopamine and phenylephrine; 78.4%, 80% and 95.2% of the time. The incidence of infiltration or extravasation was 2.7% or n = 12, for norepinephrine and 0% for dopamine and phenylephrine. Of the 12 norepinephrine cases, 67% or n = 8 were deemed to be mild harm, 8% or n = 1 was deemed to be moderate harm, 17% or n = 2 was deemed to be no harm and 8% or n = 1, was not rankable.


Conclusions: Peripheral administration of vasopressors for a short period of time with close monitoring does not result in a rate of infiltrations or extravasations that exceeds that of which is reported in the available literature.