Overview of Peripheral Vasopressor Use in an Academic Health System

Rationale: Despite historical concerns for tissue injury from extravasation, studies suggest that peripheral administration of vasopressors is safe. However, peripheral vasopressor use remains variable. Objectives: To characterize the use of peripheral vasopressors over time, identify variability in use, and assess outcomes associated with their use. Methods: We conducted a retrospective cohort study of adult patients admitted to 10 hospitals in Minnesota (October 2020-October 2023) who received any vasopressors. Patients receiving vasopressors initially through a peripheral intravenous catheter were compared with those receiving vasopressors initially through central access. Safety, efficacy, and use patterns across hospitals and providers were studied. Results: A total of 9,493 patients received vasopressors, including 3,734 with peripheral initiation and 5,759 with central initiation. Thirty-one (0.8%) of the 3,734 patients with peripheral vasopressors received phentolamine for extravasation events, with one receiving a surgical consultation for tissue necrosis. Community hospitals had the highest use of peripheral vasopressors (50.7%), and academic medical centers had the lowest use (27.6%). Initiation of vasopressors peripherally was not associated with increased hospital (adjusted odds ratio [aOR], 0.87; 95% confidence interval [CI], 0.78-0.97), 90-day (aOR, 0.92; 95% CI, 0.83-1.02), or 1-year mortality (aOR, 1.0; 95% CI, 0.91-1.11). Significant variation in use of peripheral vasopressors was observed across providers. Conclusions: Peripheral vasopressors were commonly and safely used in our 10-hospital health system, particularly in the community hospitals. Peripheral initiation of vasopressors was not associated with increased mortality at 90 days, but it was associated with decreased hospital length of stay. Variation in peripheral vasopressor use was found across hospitals and providers.