Short-Term Peripheral Vasoactive Infusions in Pediatrics: Where Is the Harm?

Area of Science:

• Pediatric critical care medicine
• Pharmacology
• Vascular access

Background:

• Pediatric shock is a significant cause of mortality, with standardized treatments improving outcomes.
• Vasoactive infusions are crucial for managing shock but have been anecdotally linked to peripheral IV complications.
• Limited pediatric evidence exists on the risks of peripheral IV infiltration and extravasation with vasoactives.

Purpose of the Study:

• To assess the frequency of peripheral IV infiltration and extravasation during vasoactive infusions in pediatric intensive care unit (PICU) patients.
• To identify risk factors associated with peripheral IV infiltration and extravasation in this population.
• To evaluate the harm resulting from such events.

Main Methods:

• Retrospective cohort study of children (0-18 years) admitted to a PICU between January 2012 and June 2014.
• Included patients received vasoactive infusions via peripheral IV for at least 1 hour.
• Data collected on patient demographics, shock diagnosis, vasoactive agents, and peripheral IV characteristics.

Main Results:

• 102 patients met inclusion criteria; 62% had septic shock.
• Dopamine was the most common vasoactive agent used.
• The incidence of peripheral IV infiltration and extravasation was 2% (2/102), with no resulting injury requiring intervention.

Conclusions:

• Vasoactive infusions administered via peripheral IV in PICU patients with shock demonstrate a low incidence of infiltration and extravasation.
• Short-term use of peripheral IVs for vasoactive infusions in a monitored PICU setting appears safe.
• Further research could explore optimal peripheral IV practices for vasoactive administration in critically ill children.