Vasopressor Administration via Peripheral Intravenous Access for Emergency Department Stabilization in Septic Shock...

Area of Science:

• Emergency Medicine
• Critical Care Medicine
• Pharmacology

Background:

• Septic shock management in the emergency department (ED) often involves vasopressors.
• Prior research indicates peripheral intravenous line (PIV) administration of vasopressors is feasible.

Purpose of the Study:

• To characterize vasopressor administration for patients with septic shock in an academic ED.
• To evaluate the safety and efficacy of PIV vasopressor administration compared to central venous access.

Main Methods:

• Retrospective observational cohort study of ED patients with septic shock from June 2018 to May 2019.
• Patients were grouped by vasopressor initiation site: PIV, ED-placed central line (ED-CVL), or prior central line (Prior-CVL).
• Data collected included demographics, vasopressor details, and length of stay; complications were monitored.

Main Results:

• Vasopressors were initiated via PIV in 49% of patients.
• No extravasation or ischemic complications were identified with PIV vasopressor administration.
• Twenty-eight-day mortality was 20.6% for PIV, 17.6% for ED-CVL, and 61.1% for Prior-CVL.

Conclusions:

• Peripheral intravenous line administration of vasopressors is a viable option for ED septic shock patients.
• Norepinephrine was the predominant vasopressor used via PIV.
• Further research on the duration of PIV use could support avoiding central venous cannulation in select patients.