Safety of peripheral intravenous administration of vasoactive medication
Abstract
BACKGROUND: Central venous access is commonly performed to administer vasoactive medication. The administration of vasoactive medication via peripheral intravenous access is a potential method of reducing the need for central venous access. The aim of this study was to evaluate the safety of vasoactive medication administered through peripheral intravenous access. METHODS: Over a 20‐month period starting in September 2012, we monitored the use of vasoactive medication via peripheral intravenous access in an 18‐bed medical intensive care unit. Norepinephrine, dopamine, and phenylephrine were all approved for use through peripheral intravenous access. RESULTS: A total of 734 patients (age 72 ± 15 years, male/female 398/336, SAPS II score 75 ± 15) received vasoactive medication via peripheral intravenous access 783 times. Vasoactive medication used was norepinephrine (n = 506), dopamine (n = 101), and phenylephrine (n = 176). The duration of vasoactive medication via peripheral intravenous access was 49 ± 22 hours. Extravasation of the peripheral intravenous access during administration of vasoactive medication occurred in 19 patients (2%) without any tissue injury following treatment, with local phentolamine injection and application of local nitroglycerin paste. There were 95 patients (13%) receiving vasoactive medication through peripheral intravenous access who eventually required central intravenous access. CONCLUSIONS: Administration of norepinephrine, dopamine, or phenylephrine by peripheral intravenous access was feasible and safe in this single‐center medical intensive care unit. Extravasation from the peripheral intravenous line was uncommon, and phentolamine with nitroglycerin paste were effective in preventing local ischemic injury. Clinicians should not regard the use of vasoactive medication is an automatic indication for central venous access. Journal of Hospital Medicine 2015;10:581–585. © 2015 Society of Hospital Medicine
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
We identified direct evidence from 14 RCTs (n = 4,499 patients) that assessed use of procalcitonin to guide antimicrobial treatment duration in patients with sepsis.
“We identified direct evidence from 14 RCTs (n = 4,499 patients) that assessed use of procalcitonin to guide antimicrobial treatment duration in patients with sepsis (two trials included critically ill patients in general) (308-321).”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [310]
Other authors showed central lines could be avoided by peripheral line insertion.
“Other authors also showed that central lines could be avoided by peripheral line insertion [387].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [387]
Cites
A randomized trial of protocol-based care for early septic shock.
The ProCESS Investigators (2014) · New England Journal of Medicine · doi:10.1056/nejmoa1401602 · Cited by 2,414 · see citing works
Marik, P. E., Baram, M., & Vahid, B. (2008) · CHEST Journal · doi:10.1378/chest.07-2331 · Cited by 1,516 · see citing works
Marik, P. E., & Cavallazzi, R. (2013) · Critical Care Medicine · doi:10.1097/ccm.0b013e31828a25fd · Cited by 866 · see citing works
Extravasation of Noncytotoxic Drugs
Le, A., & Patel, S. A. (2014) · Annals of Pharmacotherapy · doi:10.1177/1060028014527820 · Cited by 122 · see citing works
Treatment of peripheral tissue ischemia with topical nitroglycerin ointment in neonates
Wong, A., McCulloch, L. M., & Sola, A. (1992) · The Journal of Pediatrics · doi:10.1016/s0022-3476(05)80356-7 · Cited by 82 · see citing works
Phentolamine reversal of epinephrine-induced digital vasospasm. How to save an ischemic finger
Hinterberger, J. W. (1994) · Archives of Family Medicine · doi:10.1001/archfami.3.2.193 · Cited by 67 · see citing works
Reversal of Dopamine Extravasation Injury with Topical Nitroglycerin Ointment
Denkler, K. A., Cohen, B. E., & Denkler, K. A. (1989) · Plastic & Reconstructive Surgery · doi:10.1097/00006534-198911000-00017 · Cited by 64 · see citing works
Greene, S. I., & Smith, J. W. (1976) · New England Journal of Medicine · doi:10.1056/nejm197601082940221 · Cited by 56 · see citing works
Pedal Gangrene Associated with the Use of Dopamine
Alexander, C. S., Sako, Y., & Mikulic, E. (1975) · New England Journal of Medicine · doi:10.1056/nejm197509182931206 · Cited by 54 · see citing works
USE OF PHENTOLAMINE TO PREVENT NECROSIS DUE TO LEVARTERENOL
Zucker, G. (1957) · JAMA · doi:10.1001/jama.1957.82970510001009 · Cited by 48 · see citing works
Subhani, M., Sridhar, S., & DeCristofaro, J. D. (2001) · Journal of Perinatology · doi:10.1038/sj.jp.7200493 · Cited by 43 · see citing works
Extravasation Injury Associated with Low-Dose Dopamine
Chen, J. L., & O'Shea, M. (1998) · Annals of Pharmacotherapy · doi:10.1345/aph.17184 · Cited by 43 · see citing works
Acute Management of Dopamine Infiltration Injury with Regitine
Siwy, B. K., & Sadove, A. M. (1987) · Plastic & Reconstructive Surgery · doi:10.1097/00006534-198710000-00024 · Cited by 41 · see citing works
Avoidance of vascular complications associated with the use of dopamine
Stetson, J. B., & Reading, G. (1977) · Canadian Journal of Anesthesia/Journal canadien d anesthésie · doi:10.1007/bf03006717 · Cited by 26 · see citing works
(1976) · New England Journal of Medicine · doi:10.1056/nejm197601082940220 · Cited by 24 · see citing works
Cutaneous Necrosis Due to Norepinephrine
CLOSE, A. S., Frackfxton, W. H., & Kory, R. C. (1958) · Annals of Surgery · doi:10.1097/00000658-195801000-00007 · Cited by 13 · see citing works
PHENTOLAMINE HYDROCHLORIDE IN PREVENTION OF CUTANEOUS NECROSIS DUE TO LEVARTERENOL
Close, A. S. (1959) · JAMA · doi:10.1001/jama.1959.03010160032009 · Cited by 13 · see citing works
Gangrene Aggravation After Use of Dopamine
Julka, N. K. (1976) · JAMA · doi:10.1001/jama.1976.03260520012004 · Cited by 12 · see citing works
Be, C. (1989) · PubMed · Cited by 12 · see citing works
Sinclair, M. D. J., Bailey, M. A., McAree, B., et al. (2011) · Vascular Medicine · doi:10.1177/1358863x11404281 · Cited by 8 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021.
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., et al. (2021) · Critical Care Medicine · doi:10.1097/ccm.0000000000005337 · Cited by 2,935 · see citing works
Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension
The National Heart, L. (2023) · New England Journal of Medicine · doi:10.1056/nejmoa2212663 · Cited by 427 · see citing works
Safety of peripheral administration of vasopressor medications: A systematic review
Tian, D. H., Smyth, C., Keijzers, G., Macdonald, S. P., Peake, S., Udy, A., & Delaney, A. (2020) · Emergency Medicine Australasia · doi:10.1111/1742-6723.13406 · Cited by 160 · see citing works
Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., et al. (2021) · Intensive Care Medicine · doi:10.1007/s00134-021-06506-y · Cited by 5,082 · see citing works
The initial resuscitation of septic shock
Cinel, I., Kasapoglu, U. S., Gul, F., & Dellinger, R. P. (2020) · Journal of Critical Care · doi:10.1016/j.jcrc.2020.02.004 · Cited by 69 · see citing works
Delaney, A., Finnis, M., Bellomo, R., Udy, A., Jones, D., Keijzers, G., MacDonald, S., & Peake, S. (2020) · Emergency Medicine Australasia · doi:10.1111/1742-6723.13394 · Cited by 71 · see citing works
Hansen, Ø. M., & Solbakken, R. (2024) · BMJ Open · doi:10.1136/bmjopen-2023-078106 · Cited by 10 · see citing works
- Authors
- Cardenas‐Garcia, J., Schaub, K. F., Belchikov, Y. G., Narasimhan, M., Koenig, S. J., & Mayo, P. H.
- Affiliations
- Division of Pulmonary Critical Care and Sleep Medicine Hofstra North Shore–Long Island Jewish School of Medicine Hempstead New York
- Hofstra University (US)
- Westchester Medical Center (US)
- Venue
- Journal of Hospital Medicine
- Publisher
- Wiley
- Published
- 2015-05-26
- Volume
- 10
- Issue
- 9
- Pages
- 581-585
- ISSN
- 1553-5592 (ISSN-L)
- 1553-5606
- OpenAlex
- W1962642315
- Cited by
- 217
- References
- 20
- Citations by year
- 2026: 13 · 2025: 20 · 2024: 33 · 2023: 18 · 2022: 21 · 2021: 30 · 2020: 25 · 2019: 29 · 2018: 13 · 2017: 8 · 2016: 6 · 2015: 1
- FWCI
- 16.10
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Hospital Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › Emergency Medical Services › Central Venous Catheters and Hemodialysis
- Physical Sciences › Engineering › Biomedical Engineering › Intravenous Infusion Technology and Safety
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Keywords
- peripheral intravenous access, vasoactive drugs, norepinephrine, dopamine, phenylephrine, extravasation, phentolamine, central venous access, intensive care unit, hemodynamic support
- MeSH terms
- Aged, Aged, 80 and over, Cardiotonic Agents, Catheterization, Peripheral, Dopamine, Female, Humans, Infusions, Intravenous, Intensive Care Units, Male, Middle Aged, Norepinephrine, Phenylephrine, Vasoconstrictor Agents, Patient Safety, Administration, Intravenous
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
