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Peripheral and Central/Intraosseous Vasoactive Infusions During and After Pediatric Critical Care Transport:
Niha Peshimam1, Kara Bruce-Hickman1, Katrina Crawford1
1Children's Acute Transport Service, Great Ormond Street Hospital, London, United Kingdom.
Insights
Pediatric critical care transport found no significant difference in adverse events when administering vasoactive drugs via peripheral versus central venous or intraosseous catheters. This suggests both methods are comparably safe for emergency infusions.
Area of Science:
- Pediatric Critical Care Medicine
- Vascular Access Devices
- Pharmacology
Background:
- Vasoactive drug infusions are critical in pediatric critical care.
- The choice of vascular access (peripheral venous vs. central venous/intraosseous) may influence adverse event rates.
- Optimizing safe drug delivery during transport is essential.
Purpose of the Study:
- To compare the prevalence of adverse events associated with vasoactive drug infusions.
- To evaluate risks related to peripheral venous catheter use versus central venous or intraosseous catheter use.
- To inform best practices for vascular access during pediatric critical care transport.
Main Methods:
- Retrospective observational study of pediatric critical care transports.
- Reviewed medical records and incident databases for children receiving vasoactive drugs.
- Analyzed catheter-related adverse events, including extravasation, within 24 hours of PICU admission.
Main Results:
- Vasoactive drugs were administered in 14.5% of 3,836 transports.
- Adverse events occurred in 3.5% of peripheral infusions (7/198) and 2.5% of central/intraosseous infusions (9/360).
- No statistically significant difference in adverse event prevalence was observed between the two access methods.
Conclusions:
- Peripheral venous catheters and central venous/intraosseous catheters demonstrated similar safety profiles for vasoactive drug administration during pediatric critical care transport.
- The findings suggest that peripheral venous access is a viable option when central access is not immediately available.
- Further research could explore specific drug properties and patient factors influencing adverse event risk.
Objectives:
To compare the prevalence of adverse events related to vasoactive drug infusions administered via a peripheral venous catheter versus a central venous or intraosseous catheter.
Design:
Retrospective observational study.
Setting:
A pediatric critical care transport team, and the PICUs and regional hospitals within the North Thames and East Anglia regions of the United Kingdom.
Patients:
Children (up to 18 yr old) transported by the Children's Acute Transport Service receiving an infusion of a vasoactive drug (epinephrine, dobutamine, dopamine, norepinephrine, and vasopressin).
Interventions:
None.
Measurements And Main Results:
The medical records of all children transported between April 2017 and May 2020 receiving a vasoactive drug infusion were reviewed and cross-referenced with the service critical incident database. The outcome measure was anatomic catheter-related adverse events (including extravasation) reported during transport or in the first 24 hours on the PICU. During the study period, the service undertook 3,836 transports. Vasoactive drugs were administered during 558 patient transports (14.5%). During 198 of 558 transports (35.5%), vasoactive drugs were administered via a peripheral venous catheter, with seven of 198 (3.5%) adverse events. One extravasation event resulted in tissue necrosis. The median time to injury after the infusion was commenced was 60 minutes (interquartile range, 30-60 min). During 360 of 558 transports (64.5%), vasoactive infusions were administered by central venous or intraosseous catheter, with nine of 360 (2.5%) adverse events.
Conclusions:
During pediatric critical care transport, we did not find a difference in prevalence of adverse events following the administration of vasoactive drugs via peripheral venous catheters or via central venous and intraosseous catheters.
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