• Kamal Medlej, Amin Antoine Kazzi, Ahel El Hajj Chehade, Mothana Saad Eldine, Ali Chami, Rana Bachir, Dina Zebian, and Abou Dagher Gilbert G Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon..
• Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.
• J Emerg Med. 2018 Jan 1; 54 (1): 47-53.

BackgroundThe placement of a central venous catheter for the administration of vasopressors is still recommended and required by many institutions because of concern about complications associated with peripheral administration of vasopressors.ObjectiveOur aim was to determine the incidence of complications from the administration of vasopressors through peripheral venous catheters (PVC) in patients with circulatory shock, and to identify the factors associated with these complications.MethodsThis was a prospective, observational study conducted in the emergency department (ED) of a tertiary care medical center. Patients presenting to the ED with circulatory shock and in whom a vasopressor was started through a PVC were included. Research fellows examined the i.v. access site for complications twice daily during the period of peripheral vasopressor administration, then daily up to 48 h after treatment discontinuation or until the patient expired.ResultsOf the 55 patients that were recruited, 3 (5.45% overall, 6% of patients receiving norepinephrine) developed complications; none were major. Two developed local extravasation and one developed local thrombophlebitis. All three complications occurred during the vasopressor infusion, none in the 48 h after discontinuation, and none required any medical or surgical intervention. Two of the three complications occurred in the hand, and all occurred in patients receiving norepinephrine and with 20-gauge catheters.ConclusionsThe incidence of complications from the administration of vasopressors through a PVC is small and did not result in significant morbidity in this study. Larger prospective studies are needed to better determine the factors that are associated with these complications, and identify patients in whom this practice is safe.Copyright © 2017 Elsevier Inc. All rights reserved.

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