Initiation of vasopressor infusions via peripheral versus central access in patients with early septic shock: A retrospective cohort study
Open accessAbstract
Objective: To assess whether the initiation of vasopressor infusions via peripheral venous catheters (PVC) compared to central venous catheters (CVC) in ED patients with early septic shock was associated with differences in processes of care and outcomes. Methods: We conducted a post‐hoc analysis of the ARISE trial. We compared participants who had a vasopressor infusion first commenced via a PVC versus a CVC. The primary outcome was 90 day mortality. Results: We studied 937 participants. Of these, 389 (42%) had early vasopressor infusion commenced via a PVC and 548 (58%) via a CVC. Trial participants who received a vasopressor infusion via a PVC were more severely ill, with higher median (interquartile range [IQR]) Acute Physiology And Chronic Health Evaluation (APACHE II) scores (17 [13–23] versus 16 [12–21], P = 0.003), and higher median (IQR) lactate (mmol/L) (3.6 [1.9–5.8] versus 2.5 [1.5–4.5], P < 0.001). After adjusting for baseline covariates, the estimated odds ratio for mortality for PVC‐treated patients was 1.26 (95% confidence interval 0.95–1.67, P = 0.11). Trial participants who had vasopressors commenced via PVC had a shorter median (IQR) time to commencement of antimicrobials (55 [32–96] versus 71.5 [39–119] min, P < 0.001) and a shorter median (IQR) time to commencement of vasopressors (2.4 [1.3–3.9] versus 4.9 [3.5–6.6] h, P < 0.001). Conclusion: The practice of commencing a vasopressor infusion via a PVC was common in the ARISE trial and more frequent in trial participants with higher severity of illness. Commencement of a vasopressor infusion via a PVC was associated with some improvements in processes of care and, after adjustment, was not associated with an increased risk of death.
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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 [308]
Most patients who had vasopressors started peripherally achieved MAP above 65 mmHg within 1 hour.
“Moreover, most patients who had vasopressors started peripherally achieved a MAP > 65 mmHg within 1 h.”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [385]
A post-hoc analysis of the ARISE trial found 42% of patients had vasopressors initiated via peripheral catheter with shorter time to initiation.
“A post-hoc analysis of the ARISE trial showed that 42% of patients had vasopressors initiated via a peripheral catheter with a shorter time to initiation of vasopressors (2.4 [1.3–3.9] vs. 4.9 h [3.5–6.6], p < 0.001) [385].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [385]
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“Recent studies have demonstrated the safety and efficacy of early initiation of vasopressors via peripheral venous catheters with close monitoring of the patients (10,20,21).”
BackgroundYasuda, H., Rickard, C. M., Schults, J. A., Marsh, N. M., Kashiura, M., Kishihara, Y., Shinzato, Y., Amagasa, S., Moriya, T., Kotani, Y., et al. (2025) · Emergency Medicine International · doi:10.1155/emmi/4457109 · Cited by 3 · see citing works
Martinez-Solarte, M., Fernández‐Sarmiento, J., Guzman, L., Fernández-Sarta, D., Gutiérrez-Montenegro, L., Sarmiento-Moreno, A. M., Mulett, H., Fernández-Palacio, M. C., Suárez, J. D., Mejía, J., et al. (2025) · Frontiers in Pediatrics · doi:10.3389/fped.2025.1719260 · Cited by 3 · see citing works
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Self-citationPRO: Vasopressors Can Be Administered Safely via a Peripheral Intravenous Catheter
Darwish, D., & Karamchandani, K. (2024) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2024.02.009 · Cited by 3 · see citing works
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Analyzing outcomes for peripheral versus central administration of vasopressors: A narrative review
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“[76] Sound randomized clinical trials may still be needed to ascertain the relative risks and benefits.”
Update 2025 der S3-Leitlinie: „Sepsis – Prävention, Diagnose, Therapie und Nachsorge“
Neumann, C., Ebert, D., Bucher, M., & Bauer, M. W. (2025) · Die Anaesthesiologie · doi:10.1007/s00101-025-01609-3 · Cited by 3 · see citing works
“Damit kann überbrückend bis zur Anlage eines zen-tralen Venenkatheters, wie im Fallbeispiel aufgezeigt, die Zeit bis zum Beginn einer Vasopressortherapie verkürzt [12] und die Mortalität reduziert werden [13].”
Fármacos vasoactivos en el tratamiento del shock séptico
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Administración segura de noradrenalina por vía periférica: una revisión sistemática
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“The use of peripheral administration of vasopressor therapy has also been evaluated in different clinical settings showing high safety if handled correctly [56–61], while also providing shorter time to vasopressor initiation [19, 62, 63].”
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Was ist gesichert in der Therapie der Sepsis?
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“Davon wird zunehmend abgewichen; eine (kurzfristige) periphere Gabe scheint sicher zu sein, wenn damit ein prolongierter Schock aufgrund einer verzögerten Vasopressorgabe vermieden werden kann [16, 17].”
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Vasopressors in Septic Shock: The Quest for Refinement
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Die aktuelle Sepsisleitlinie – was müssen Sie wissen?
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“Außerdemistdie periphere Verabreichung von Vasopresso-ren mit einer kürzeren Zeit bis zur Applikation und einem schnelleren Erreichen des Zielblutdrucks verbunden [33].”
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S3-Leitlinie Sepsis – Prävention, Diagnose, Therapie und Nachsorge – Update 2025
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Vasopressor Therapy in Septic Shock: Central Line or Peripheral Line
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Navigating the veins: A comprehensive review of vasoactive agent infusion via peripheral routes
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- Authors
- Delaney, A., Finnis, M., Bellomo, R., Udy, A., Jones, D., Keijzers, G., MacDonald, S., & Peake, S.
- Affiliations
- Royal North Shore Hospital (AU)
- Royal Adelaide Hospital (AU)
- Austin Hospital (AU)
- The Alfred Hospital (AU)
- Griffith University (AU)
- The University of Western Australia (AU)
- Queen Elizabeth Hospital (AU)
- Corresponding author
- Delaney, Anthony
- ORCID
- Venue
- Emergency Medicine Australasia
- Publisher
- Wiley
- Published
- 2019-10-09
- Volume
- 32
- Issue
- 2
- Pages
- 210-219
- ISSN
- 1035-6851 (ISSN-L)
- 1742-6731
- 1742-6723
- OpenAlex
- W2979776779
- Cited by
- 71
- References
- 33
- Citations by year
- 2026: 7 · 2025: 9 · 2024: 13 · 2023: 14 · 2022: 11 · 2021: 13 · 2020: 3 · 2014: 1
- FWCI
- 5.14
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- Locations
- Emergency Medicine Australasia (publishedVersion)
- PubMed (publishedVersion)
- Bond University Research Portal (Bond University) (submittedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Minerva Access (University of Melbourne) (submittedVersion)
- Griffith Research Online (submittedVersion, other-oa)
- Funders
- Australian National Health and Medical Research Council (491075, APP1021165)
- Topics
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Health Professions › Emergency Medical Services › Central Venous Catheters and Hemodialysis
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Keywords
- septic shock, vasopressor infusion, peripheral intravenous catheters, central venous catheters, 90-day mortality, ARISE trial, time to treatment, emergency department care, sepsis
- MeSH terms
- Catheterization, Peripheral, Humans, Retrospective Studies, Shock, Septic, Vasoconstrictor Agents, APACHE
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