Safety of peripheral intravenous administration of vasoactive medication

Jose Cardenas-Garcia, Karen F. Schaub, Yuly G. Belchikov, Mangala Narasimhan, Seth J. Koenig, Paul H. Mayo

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

BACKGROUND: Central venous access is commonly performed to administer vasoactive medication. The administration of vasoactive medication via peripheral intravenous access is a potential method of reducing the need for central venous access. The aim of this study was to evaluate the safety of vasoactive medication administered through peripheral intravenous access. METHODS: Over a 20-month period starting in September 2012, we monitored the use of vasoactive medication via peripheral intravenous access in an 18-bed medical intensive care unit. Norepinephrine, dopamine, and phenylephrine were all approved for use through peripheral intravenous access. RESULTS: A total of 734 patients (age 72±15 years, male/female 398/336, SAPS II score 75±15) received vasoactive medication via peripheral intravenous access 783 times. Vasoactive medication used was norepinephrine (n=506), dopamine (n=101), and phenylephrine (n=176). The duration of vasoactive medication via peripheral intravenous access was 49±22 hours. Extravasation of the peripheral intravenous access during administration of vasoactive medication occurred in 19 patients (2%) without any tissue injury following treatment, with local phentolamine injection and application of local nitroglycerin paste. There were 95 patients (13%) receiving vasoactive medication through peripheral intravenous access who eventually required central intravenous access. CONCLUSIONS: Administration of norepinephrine, dopamine, or phenylephrine by peripheral intravenous access was feasible and safe in this single-center medical intensive care unit. Extravasation from the peripheral intravenous line was uncommon, and phentolamine with nitroglycerin paste were effective in preventing local ischemic injury. Clinicians should not regard the use of vasoactive medication is an automatic indication for central venous access.

Original languageEnglish (US)
Pages (from-to)581-585
Number of pages5
JournalJournal of Hospital Medicine
Volume10
Issue number9
DOIs
StatePublished - Sep 1 2015

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Phenylephrine
Intravenous Administration
Dopamine
Norepinephrine
Phentolamine
Nitroglycerin
Ointments
Safety
Intensive Care Units
Wounds and Injuries
Injections
Therapeutics

All Science Journal Classification (ASJC) codes

  • Leadership and Management
  • Fundamentals and skills
  • Health Policy
  • Care Planning
  • Assessment and Diagnosis

Cite this

Cardenas-Garcia, J., Schaub, K. F., Belchikov, Y. G., Narasimhan, M., Koenig, S. J., & Mayo, P. H. (2015). Safety of peripheral intravenous administration of vasoactive medication. Journal of Hospital Medicine, 10(9), 581-585. https://doi.org/10.1002/jhm.2394
Cardenas-Garcia, Jose ; Schaub, Karen F. ; Belchikov, Yuly G. ; Narasimhan, Mangala ; Koenig, Seth J. ; Mayo, Paul H. / Safety of peripheral intravenous administration of vasoactive medication. In: Journal of Hospital Medicine. 2015 ; Vol. 10, No. 9. pp. 581-585.
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abstract = "BACKGROUND: Central venous access is commonly performed to administer vasoactive medication. The administration of vasoactive medication via peripheral intravenous access is a potential method of reducing the need for central venous access. The aim of this study was to evaluate the safety of vasoactive medication administered through peripheral intravenous access. METHODS: Over a 20-month period starting in September 2012, we monitored the use of vasoactive medication via peripheral intravenous access in an 18-bed medical intensive care unit. Norepinephrine, dopamine, and phenylephrine were all approved for use through peripheral intravenous access. RESULTS: A total of 734 patients (age 72±15 years, male/female 398/336, SAPS II score 75±15) received vasoactive medication via peripheral intravenous access 783 times. Vasoactive medication used was norepinephrine (n=506), dopamine (n=101), and phenylephrine (n=176). The duration of vasoactive medication via peripheral intravenous access was 49±22 hours. Extravasation of the peripheral intravenous access during administration of vasoactive medication occurred in 19 patients (2{\%}) without any tissue injury following treatment, with local phentolamine injection and application of local nitroglycerin paste. There were 95 patients (13{\%}) receiving vasoactive medication through peripheral intravenous access who eventually required central intravenous access. CONCLUSIONS: Administration of norepinephrine, dopamine, or phenylephrine by peripheral intravenous access was feasible and safe in this single-center medical intensive care unit. Extravasation from the peripheral intravenous line was uncommon, and phentolamine with nitroglycerin paste were effective in preventing local ischemic injury. Clinicians should not regard the use of vasoactive medication is an automatic indication for central venous access.",
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Cardenas-Garcia, J, Schaub, KF, Belchikov, YG, Narasimhan, M, Koenig, SJ & Mayo, PH 2015, 'Safety of peripheral intravenous administration of vasoactive medication', Journal of Hospital Medicine, vol. 10, no. 9, pp. 581-585. https://doi.org/10.1002/jhm.2394

Safety of peripheral intravenous administration of vasoactive medication. / Cardenas-Garcia, Jose; Schaub, Karen F.; Belchikov, Yuly G.; Narasimhan, Mangala; Koenig, Seth J.; Mayo, Paul H.

In: Journal of Hospital Medicine, Vol. 10, No. 9, 01.09.2015, p. 581-585.

Research output: Contribution to journalArticle

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N2 - BACKGROUND: Central venous access is commonly performed to administer vasoactive medication. The administration of vasoactive medication via peripheral intravenous access is a potential method of reducing the need for central venous access. The aim of this study was to evaluate the safety of vasoactive medication administered through peripheral intravenous access. METHODS: Over a 20-month period starting in September 2012, we monitored the use of vasoactive medication via peripheral intravenous access in an 18-bed medical intensive care unit. Norepinephrine, dopamine, and phenylephrine were all approved for use through peripheral intravenous access. RESULTS: A total of 734 patients (age 72±15 years, male/female 398/336, SAPS II score 75±15) received vasoactive medication via peripheral intravenous access 783 times. Vasoactive medication used was norepinephrine (n=506), dopamine (n=101), and phenylephrine (n=176). The duration of vasoactive medication via peripheral intravenous access was 49±22 hours. Extravasation of the peripheral intravenous access during administration of vasoactive medication occurred in 19 patients (2%) without any tissue injury following treatment, with local phentolamine injection and application of local nitroglycerin paste. There were 95 patients (13%) receiving vasoactive medication through peripheral intravenous access who eventually required central intravenous access. CONCLUSIONS: Administration of norepinephrine, dopamine, or phenylephrine by peripheral intravenous access was feasible and safe in this single-center medical intensive care unit. Extravasation from the peripheral intravenous line was uncommon, and phentolamine with nitroglycerin paste were effective in preventing local ischemic injury. Clinicians should not regard the use of vasoactive medication is an automatic indication for central venous access.

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Cardenas-Garcia J, Schaub KF, Belchikov YG, Narasimhan M, Koenig SJ, Mayo PH. Safety of peripheral intravenous administration of vasoactive medication. Journal of Hospital Medicine. 2015 Sep 1;10(9):581-585. https://doi.org/10.1002/jhm.2394