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Waxman MJ, Schechter-Perkins EM. Peripheral Intravenous Catheters Are Preferable for Emergency Department Patients With Septic Shock. Ann Emerg Med 2024; 83:607-608. [PMID: 38456867 DOI: 10.1016/j.annemergmed.2024.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 01/15/2024] [Accepted: 01/23/2024] [Indexed: 03/09/2024]
Affiliation(s)
- Michael J Waxman
- Department of Emergency Medicine, Albany Medical College, Albany, NY
| | - Elissa M Schechter-Perkins
- Department of Emergency Medicine, Boston Medical Center/Boston University Chobanian and Avedisian School of Medicine, Boston, MA
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Watts S, Apte Y, Holland T, Hatt A, Craswell A, Lin F, Tabah A, Ware R, Byrnes J, Anstey C, Keijzers G, Ramanan M. Randomised, controlled, feasibility trial comparing vasopressor infusion administered via peripheral cannula versus central venous catheter for critically ill adults: A study protocol. PLoS One 2024; 19:e0295347. [PMID: 38739611 PMCID: PMC11090297 DOI: 10.1371/journal.pone.0295347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/11/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND When clinicians need to administer a vasopressor infusion, they are faced with the choice of administration via either peripheral intravenous catheter (PIVC) or central venous catheter (CVC). Vasopressor infusions have traditionally been administered via central venous catheters (CVC) rather than Peripheral Intra Venous Catheters (PIVC), primarily due to concerns of extravasation and resultant tissue injury. This practice is not guided by contemporary randomised controlled trial (RCT) evidence. Observational data suggests safety of vasopressor infusion via PIVC. To address this evidence gap, we have designed the "Vasopressors Infused via Peripheral or Central Access" (VIPCA) RCT. METHODS The VIPCA trial is a single-centre, feasibility, parallel-group RCT. Eligible critically ill patients requiring a vasopressor infusion will be identified by emergency department (ED) or intensive care unit (ICU) staff and randomised to receive vasopressor infusion via either PIVC or CVC. Primary outcome is feasibility, a composite of recruitment rate, proportion of eligible patients randomised, protocol fidelity, retention and missing data. Primary clinical outcome is days alive and out of hospital up to day-30. Secondary outcomes will include safety and other clinical outcomes, and process and cost measures. Specific aspects of safety related to vasopressor infusions such as extravasation, leakage, device failure, tissue injury and infection will be assessed. DISCUSSION VIPCA is a feasibility RCT whose outcomes will inform the feasibility and design of a multicentre Phase-3 trial comparing routes of vasopressor delivery. The exploratory economic analysis will provide input data for the full health economic analysis which will accompany any future Phase-3 RCT.
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Affiliation(s)
| | - Yogesh Apte
- Caboolture Hospital, Caboolture, Australia
- James Mayne Academy of Critical Care, The University of Queensland, Brisbane, Australia
| | | | - April Hatt
- Caboolture Hospital, Caboolture, Australia
| | - Alison Craswell
- Caboolture Hospital, Caboolture, Australia
- School of Health, University of the Sunshine Coast, Sippy Downs, Australia
| | - Frances Lin
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Sunshine Coast Health Institute, School of Health, University of the Sunshine Coast, Sippy Downs, Australia
| | - Alexis Tabah
- James Mayne Academy of Critical Care, The University of Queensland, Brisbane, Australia
- Intensive Care Unit, Redcliffe Hospital, Brisbane, Australia
- Faculty of Health, Queensland University of Technology, Brisbane, Australia
- Queensland Critical Care Research Network, Herston, Australia
| | - Robert Ware
- Menzies Health Institute Queensland and School of Medicine and Dentistry, Griffith University, Southport, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Southport, Australia
| | - Christopher Anstey
- Menzies Health Institute Queensland and School of Medicine and Dentistry, Griffith University, Southport, Australia
| | - Gerben Keijzers
- Menzies Health Institute Queensland and School of Medicine and Dentistry, Griffith University, Southport, Australia
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Southport, Australia
- Faculty of Health Sciences and Medicine Bond University, Robina, Australia
| | - Mahesh Ramanan
- Caboolture Hospital, Caboolture, Australia
- Queensland Critical Care Research Network, Herston, Australia
- Critical Care Division, The George Institute for Global Health, University of New South Wales, Kensington, Australia
- Faculty of Health, Queensland of Technology, Brisbane, Australia
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García-Uribe J, Lopera-Jaramillo D, Gutiérrez-Vargas J, Arteaga-Noriega A, Bedoya OA. Adverse effects related with norepinephrine through short peripheral venous access: Scoping review. ENFERMERIA INTENSIVA 2023; 34:218-226. [PMID: 36935306 DOI: 10.1016/j.enfie.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 09/01/2022] [Indexed: 03/19/2023]
Abstract
Peripheral administration of norepinephrine is restricted due to the association of extravasation with tissue necrosis. METHOD Scoping review with the objective of describing the adverse effects related to the administration of norepinephrine through short peripheral venous access and the characteristics of drug administration in patients hospitalized in ICU, surgery, and emergency services. RESULTS 12 studies with heterogeneous characteristics by size and type of population were included. The proportion of complications associated with peripheral norepinephrine administration was less than 12% in observational studies and it was less than 2% in those that used doses less than 0.13μg/kg/min, and concentrations less than 22.3μg/mL. The main associated complication was extravasation and there were no cases of tissue necrosis at the venipuncture site, some extravasation cases were treated with phentolamine, terbutaline or topical nitroglycerin. The drug administration time ranged between 1 and 528hours with a weighted mean of 2.78h. CONCLUSION The main adverse effect was extravasation, no additional complications occurred, phentolamine and terbutaline seem to be useful, and its availability is a necessity. It is essential for the nursing staff to carry out a close assessment and comprehensive care in patients receiving norepinephrine by peripheral route.
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Affiliation(s)
- J García-Uribe
- Facultad de Ciencias de la Salud, Corporación Universitaria Remington, Medellín, Colombia.
| | - D Lopera-Jaramillo
- Facultad de Ciencias de la Salud, Corporación Universitaria Remington, Medellín, Colombia.
| | - J Gutiérrez-Vargas
- Grupo de Investigación Salud Familiar y Comunitaria, Facultad de Ciencias de la Salud, Corporación Universitaria Remington, Medellín, Colombia.
| | - A Arteaga-Noriega
- Grupo de Investigación Salud Familiar y Comunitaria, Facultad de Ciencias de la Salud, Corporación Universitaria Remington, Medellín, Colombia.
| | - O A Bedoya
- Grupo de Investigación Salud Familiar y Comunitaria, Facultad de Ciencias de la Salud, Corporación Universitaria Remington, Medellín, Colombia.
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Gershengorn HB, Basu T, Horowitz JK, McLaughlin E, Munroe E, O'Malley M, Hsaiky L, Flanders SA, Bernstein SJ, Paje D, Chopra V, Prescott HC. The Association of Vasopressor Administration through a Midline Catheter with Catheter-related Complications. Ann Am Thorac Soc 2023; 20:1003-1011. [PMID: 37166852 DOI: 10.1513/annalsats.202209-814oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 02/27/2023] [Indexed: 03/02/2023] Open
Abstract
Rationale: Little is known about the safety of infusing vasopressors through a midline catheter. Objectives: To evaluate safety outcomes after vasopressor administration through a midline. Methods: We conducted a cohort study of adults admitted to 39 hospitals in Michigan (December 2017-March 2022) who received vasopressors while either a midline or peripherally inserted central catheter (PICC) was in place. Patients receiving vasopressors through a midline were compared with those receiving vasopressors through a PICC and, separately, to those with midlines in place but who received vasopressors through a different catheter. We used descriptive statistics to characterize and compare cohort characteristics. Multivariable mixed effects logistic regression models were fit to determine the association between vasopressor administration through a midline with outcomes, primarily catheter-related complications (bloodstream infection, superficial thrombophlebitis, exit site infection, or catheter occlusion). Results: Our cohort included 287 patients with midlines through which vasopressors were administered, 1,660 with PICCs through which vasopressors were administered, and 884 patients with midlines who received vasopressors through a separate catheter. Age (median [interquartile range]: 68.7 [58.6-75.7], 66.6 [57.1-75.0], and 67.6 [58.7-75.8] yr) and gender (percentage female: 50.5%, 47.3%, and 43.8%) were similar in all groups. The frequency of catheter-related complications was lower in patients with midlines used for vasopressors than PICCs used for vasopressors (5.2% vs. 13.4%; P < 0.001) but similar to midlines with vasopressor administration through a different device (5.2% vs. 6.3%; P = 0.49). After adjustment, administration of vasopressors through a midline was not associated with catheter-related complications compared with PICCs with vasopressors (adjusted odds ratios [aOR], 0.65 [95% confidence interval, 0.31-1.33]; P = 0.23) or midlines with vasopressors elsewhere (aOR, 0.85 [0.46-1.58]; P = 0.59). Midlines used for vasopressors were associated with greater risk of systemic thromboembolism (vs. PICCs with vasopressors: aOR, 2.69 [1.31-5.49]; P = 0.008; vs. midlines with vasopressors elsewhere: aOR, 2.42 [1.29-4.54]; P = 0.008) but not thromboses restricted to the ipsilateral upper extremity (vs. PICCs with vasopressors: aOR, 2.35 [0.83-6.63]; P = 0.10; model did not converge for vs. midlines with vasopressors elsewhere). Conclusions: We found no significant association of vasopressor administration through a midline with catheter-related complications. However, we identified increased odds of systemic (but not ipsilateral upper extremity) venous thromboembolism warranting further evaluation.
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Affiliation(s)
- Hayley B Gershengorn
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
- Division of Critical Care Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Tanima Basu
- Division of Hospital Medicine and
- The Hospital Medicine Safety Consortium Coordinating Center, Ann Arbor, Michigan
| | - Jennifer K Horowitz
- Division of Hospital Medicine and
- The Hospital Medicine Safety Consortium Coordinating Center, Ann Arbor, Michigan
| | - Elizabeth McLaughlin
- Division of Hospital Medicine and
- The Hospital Medicine Safety Consortium Coordinating Center, Ann Arbor, Michigan
| | - Elizabeth Munroe
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Megan O'Malley
- Division of Hospital Medicine and
- The Hospital Medicine Safety Consortium Coordinating Center, Ann Arbor, Michigan
| | - Lama Hsaiky
- Department of Pharmacy, Beaumont Hospital, Dearborn, Michigan
| | - Scott A Flanders
- Division of Hospital Medicine and
- The Hospital Medicine Safety Consortium Coordinating Center, Ann Arbor, Michigan
| | - Steven J Bernstein
- The Hospital Medicine Safety Consortium Coordinating Center, Ann Arbor, Michigan
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Division of General Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan; and
| | - David Paje
- Division of Hospital Medicine and
- The Hospital Medicine Safety Consortium Coordinating Center, Ann Arbor, Michigan
| | - Vineet Chopra
- The Hospital Medicine Safety Consortium Coordinating Center, Ann Arbor, Michigan
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Hallie C Prescott
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
- The Hospital Medicine Safety Consortium Coordinating Center, Ann Arbor, Michigan
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
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García-Uribe J, Lopera-Jaramillo D, Gutiérrez-Vargas J, Arteaga-Noriega A, Bedoya O. Efectos adversos relacionados con la administración de norepinefrina por accesos venosos periféricos cortos: una revisión de alcance. ENFERMERIA INTENSIVA 2023. [DOI: 10.1016/j.enfi.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Update on prevention of intra-vascular accesses complications. Intensive Care Med 2022; 48:1422-1425. [PMID: 35768729 DOI: 10.1007/s00134-022-06763-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/26/2022] [Indexed: 02/04/2023]
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