Evaluation of the safety and efficacy of peripheral vasopressors to decrease central line placement and associated...

Area of Science:

• Critical Care Medicine
• Vascular Access
• Patient Safety

Background:

• Institutions are exploring alternatives to central venous catheters for vasopressor administration.
• A pilot program demonstrated the safety of peripheral vasopressor infusions.
• An institutional protocol was developed to expand peripheral vasopressor use.

Purpose of the Study:

• To evaluate the efficacy and safety of peripheral vasopressor infusions.
• To reduce the incidence of unnecessary central line placement and associated complications.
• To decrease the duration of central line days in intensive care unit patients.

Main Methods:

• A single-center, retrospective, pre- and post-intervention chart review was conducted.
• Patients over 18 years old admitted to the ICU requiring vasopressors were included.
• Exclusion criteria included limitations in peripheral intravenous access or limb restrictions.

Main Results:

• Peripheral vasopressor use resulted in a 58.4% decrease in central line placements (p < .001).
• 14 extravasation events occurred in 382 peripheral vasopressor administrations.
• A statistically significant reduction in central line-associated bloodstream infections (CLABSI) was observed.

Conclusions:

• Peripheral vasopressor administration is safe and effective when utilized appropriately.
• Infusions should be proximal to the antecubital fossa, at lower doses, and for short durations.
• This protocol reduces central line necessity and associated risks in ICU patients.