Volume 6, Issue 7 p. 709-717
CLINICAL PHARMACY RESEARCH REPORT

Comparison of extravasation events related to the peripheral administration of vasopressors prior to and following implementation of an institutional protocol

Allison C. Fabick Pharm.D.

Corresponding Author

Allison C. Fabick Pharm.D.

Department of Pharmacy Services, Medical University of South Carolina, Charleston, South Carolina, USA

Correspondence

Allison C. Fabick, 7101 Jahnke Rd. Richmond, VA 23225, USA.

Email: [email protected]

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Jaclyn M. Hawn Pharm.D.

Jaclyn M. Hawn Pharm.D.

Department of Pharmacy Services, Medical University of South Carolina, Charleston, South Carolina, USA

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Katharine W. Barwick Pharm.D.

Katharine W. Barwick Pharm.D.

Department of Pharmacy Services, Medical University of South Carolina, Charleston, South Carolina, USA

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Erin R. Weeda Pharm.D.

Erin R. Weeda Pharm.D.

Department of Pharmacy Services, Medical University of South Carolina, Charleston, South Carolina, USA

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Andrew J. Goodwin M.D.

Andrew J. Goodwin M.D.

Division of Pulmonary, Critical Care, Allergy & Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina, USA

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Carolyn M. Bell Pharm.D.

Carolyn M. Bell Pharm.D.

Department of Pharmacy Services, Medical University of South Carolina, Charleston, South Carolina, USA

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First published: 18 June 2023

Abstract

Introduction

Following adequate fluid resuscitation, vasopressors are often utilized to maintain perfusion in shock states. Traditionally, vasopressors are administered via a central venous catheter (CVC) to attempt to minimize extravasation events. New literature advocates for peripheral vasopressor administration when CVC placement could lead to a delay in care. The purpose of this study was to compare extravasation events during vasopressor administration via a peripheral intravenous line (PIV) prior to and following the implementation of an institutional peripheral vasopressor protocol.

Methods

This was a single-center, retrospective, observational study conducted at a large academic medical center. Adult patients admitted to an intensive care unit (ICU) from September 2018 to 2020 who received continuous infusion vasopressors were included. Vasopressors evaluated were norepinephrine, epinephrine, phenylephrine, dopamine, and vasopressin. The primary outcome evaluated extravasation events prior to and following the implementation of an institutional peripheral vasopressor protocol.

Results

Of the 3430 patients included, 1532 and 1898 patients were in the pre- and post-protocol implementation groups. Following protocol implementation, there was an increase in PIV utilization, improvement in ultrasound-guided PIV placement (17% vs. 26%, p < 0.001), and line assessment every 2 h (74% vs. 90%, p < 0.001). Less non-compliance in vasopressor infusion rates (40% vs. 24%, p < 0.001) and PIV location (18% vs. 10%, p < 0.001) were also observed following protocol implementation. A total of 58 extravasation events occurred in both groups, 15 confirmed events and 43 suspected events. Following protocol implementation, there were less extravasation events (2.4% [n = 37] pre- vs. 1.1% [n = 21] post-protocol p = 0.003).

Conclusion

Following the implementation of an institutional protocol, there was a reduction in extravasation events, an improvement in ultrasound-guided PIV placement, and the use of peripheral infusion practices associated with increased safety. Additional studies are needed to determine the optimal peripheral vasopressor protocol to reduce CVC use and maintain reduced extravasation events.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflicts of interest.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.