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Updated: Jun 14, 2025

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Local Adverse Events Associated with Peripheral Vasoactive Infusion in Children: A Systematic Review with

Jun Takeshita1, Atsushi Kawaguchi2, Tatsuya Kawasaki3

  • 1Department of Anesthesiology, Osaka Prefectural Hospital Organization, Osaka Women's and Children's Hospital, Osaka, Japan.

Journal of Cardiothoracic and Vascular Anesthesia
|September 3, 2024
PubMed

Insights

Peripheral infusion of vasoactive agents like epinephrine and norepinephrine in children has a low incidence of local adverse events. This systematic review supports its consideration when necessary for critically ill pediatric patients.

Area of Science:

  • Pediatric Critical Care Medicine
  • Pharmacology
  • Evidence-Based Medicine

Background:

  • Previous studies indicated low local adverse events with peripheral vasoactive agent infusion in children.
  • However, prior analyses included limited patient numbers and primarily focused on dopamine.

Purpose of the Study:

  • To systematically review and meta-analyze the safety of infusing vasoactive agents (epinephrine, norepinephrine) via peripheral venous or intraosseous access in critically ill children.
  • To determine the incidence of local adverse events, such as extravasation or infiltration.

Main Methods:

  • Updated systematic review and meta-analysis of MEDLINE (PubMed) and Cochrane Central Register of Controlled Trials.
  • Included 12 observational studies and 1 randomized controlled trial.

Main Results:

  • Pooled incidence of local adverse events for peripheral venous or intraosseous access: 2.1% (95% CI: 0.8%-3.9%).
  • Pooled incidence for peripheral venous catheters only: 2.3% (95% CI: 1.0%-4.0%).
  • Pooled incidence for intraosseous access only: 1.1% (95% CI: 0.0%-9.8%).

Conclusions:

  • The incidence of local adverse events associated with peripheral vasoactive infusion in critically ill children is low.
  • Peripheral infusion of vasoactive agents, including epinephrine and norepinephrine, is a viable option when clinically indicated.

Keywords:
childcritical illnessdopamineepinephrineintraosseous accessnorepinephrineperipheral venous catheter

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