Peripheral Inotropes in Critically Ill Children: Is It Safe?

Area of Science:

• Pediatric critical care medicine
• Pharmacology
• Vascular access

Background:

• Pediatric intensive care units (PICUs) frequently require inotropes for critically ill children.
• Central venous access may be delayed or unavailable, especially in low- and middle-income countries (LMICs).
• Peripheral venous access is often used for vasoactive medication administration in these settings.

Purpose of the Study:

• To describe the role and safety of peripheral vasoactive inotropes in pediatric patients.
• To evaluate the incidence of complications, specifically extravasation injury, associated with peripheral inotrope administration.

Main Methods:

• Retrospective data collection from children requiring peripheral vasoactive medications.
• Data collected at two time points, including pre-COVID era and during the COVID pandemic.
• Analysis of the use and complications of peripheral vasoactive medications.

Main Results:

• Eighty-four children received peripheral vasoactive medications (51 pre-COVID, 33 during COVID).
• Only 3% (3/84) of children experienced extravasation injury.
• All children who developed extravasation injury recovered completely.

Conclusions:

• Peripheral inotrope infusion in children is associated with a very low rate of extravasation injury (3%).
• Diluted concentrations of peripheral vasoactive inotropes can be safely administered to pediatric patients.
• This approach offers a viable option for hemodynamic support when central access is limited.