The effect of peripheral vasopressor protocols on extravasation rates: A systematic review and meta-analysis

Central venous catheters have been historically preferred over peripheral venous catheters for the administration of vasoactive medications in critically ill patients to reduce the risk of extravasation. Peripheral vasopressor administration is gaining attention as a strategy to expedite initiation while avoiding the procedural risks of central venous catheter placement. Although prior systematic reviews have focused on anatomical site and peripheral venous catheter gauge, the impact of implementing a peripheral vasopressor protocol on the safety profile of peripheral vasopressor administration has not been systematically evaluated.

To determine whether a peripheral vasopressor protocol influences the safety profile of peripherally administered vasopressors in critically ill patients.

A comprehensive search was conducted across MEDLINE (Ovid), Embase (Ovid), the Cochrane Central Register of Controlled Trials (Ovid), and PubMed, encompassing studies published since January 2000. Statistical analysis was conducted using R (v. 4.4.3; https://www.r-project.org/), with two-tailed significance set at p < 0.05.

A total of 22 studies involving 10,983 adult patients (≥18 years) were identified. Median extravasation rates were similar between studies using a peripheral vasopressor protocol and those not (33.5 [12.3-53.0] vs. 31.2 [12.0-39.6] per 1000 patients), with no statistically significant difference (U = 68, p = 0.78).

This review demonstrated that peripheral vasopressor protocols did not yield statistically significant reductions in extravasation rates among patients receiving peripheral vasopressor therapy.