Complication of vasopressor infusion through peripheral venous catheter: A systematic review and meta-analysis

• Published in: The American journal of emergency medicine Vol. 38; no. 11; pp. 2434 - 2443
• Main Authors: Tran, Quincy K., Mester, Gaurika, Bzhilyanskaya, Vera, Afridi, Leenah Z., Andhavarapu, Sanketh, Alam, Zain, Widjaja, Austin, Andersen, Brooke, Matta, Ann, Pourmand, Ali
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2020; Elsevier Limited
• Subjects: Adverse events; Agreements; Bias; Case reports; Catheterization, Central Venous; Catheterization, Peripheral; Catheters; Central Venous Catheters; Clinical trials; Complications; Emergency medical care; Emergency Service, Hospital; Erythema - epidemiology; Erythema - etiology; Extravasation of Diagnostic and Therapeutic Materials - epidemiology; Extravasation of Diagnostic and Therapeutic Materials - etiology; Health risks; Humans; Infusions, Intravenous - adverse effects; Infusions, Intravenous - methods; Intensive Care Units; Medical instruments; Meta-analysis; Mortality; Peripheral intravenous catheters; Point of care testing; Practice Guidelines as Topic; Safety; Sepsis; Shock - drug therapy; Systematic review; Time-to-Treatment; Ultrasonic imaging; Vasoactive medication; Vasoconstrictor Agents - administration & dosage; Vasopressors; Venous Thrombosis - epidemiology; Venous Thrombosis - etiology; United States > US; Vasopressors; Vasoactive medication; Central venous catheters; Peripheral intravenous catheters; Adverse events; Complications
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2020.09.047

Vasopressors are mainstay treatment for patients in shock and are usually infused through central venous catheters (CVCs). However, CVCs are associated with risk of infection or delay from the needs of confirmation of placement. Infusing vasopressor through peripheral venous catheter (PIVs) could be an alternative in the Emergency Departments (ED) but data regarding complications is inconclusive. We performed a random-effects meta-analysis to assess literature involving prevalence of complications from infusing vasopressors via PIVs.
We searched PubMed, EMBASE and Scopus databases from beginnings to 02/02/2020 to identify relevant randomized control trials, cohort, case-control studies. We excluded case reports. Authors assessed studies' quality with Newcastle-Ottawa Scale and Cochrane Risk of Bias tool. Kappa score was used to assess interrater agreement. Outcome was complications as direct results from infusing vasopressors through PIVs.
We identified 325 articles and included 9 studies after reviewing 16 full text articles. Our analysis included 1835 patients whose mean age was 63 (Standard Deviation 12) years and 48% was female. There were 122 (7%) complications, of which 117 (96%) were minor. The meta-analysis with random effects showed the pooled prevalence of complications as 0.086 (95%CI 0.031–0.21). Studies reporting infusion safety guidelines had significantly lower prevalence of complications (0.029, 95%CI 0.018–0.045), compared to those not reporting a safety guideline (0.12, 95%CI 0.038–0.30, p = 0.024).
There was low prevalence of complications as a direct result from infusing vasopressors through PIVs. Studies with safety guidelines were associated with significantly lower prevalence of complications. Further studies are needed to confirm our observations.