Safety of peripheral administration of vasopressor medications: A systematic review
Open accessAbstract
Objective: Vasopressor medications have traditionally been administered via central venous catheters (CVCs), primarily due to concerns of peripheral extravasation of vasoconstrictive medications. Recent studies have suggested that vasopressor administration via peripheral intravenous catheters (PiVCs) may be a feasible and safe alternative. This systematic review evaluates the safety of delivering vasopressor medications via PiVCs. Methods: We performed a systematic review to assess the frequency of complications associated with the delivery of vasopressors via PiVCs. A literature search for prospective and retrospective studies of vasopressor infusions in adults was performed. We included studies of continuous infusions of vasopressor medications (noradrenaline, adrenaline, metaraminol, phenylephrine, dopamine and vasopressin) delivered via a PiVCs that included at least 20 patients. Data on patient factors, cannulation approach, monitoring protocols, vasopressor dosing and dilutions and adverse events were collected and summarised. Results: Seven studies were identified that fulfilled the inclusion criteria, including 1382 patients. No study fulfilled all of the validity criteria. Noradrenaline was the most commonly administered agent (n = 702 episodes of administration), followed by phenylephrine (n = 546), dopamine (n = 108), metaraminol (n = 74) and vasopressin and adrenaline (<5 patients). Mean duration of infusion was 22 h (95% confidence interval [CI] 8–36 h). Extravasation occurred in 3.4% (95% CI 2.5–4.7%) of patients. There were no reported episodes of tissue necrosis or limb ischaemia. All extravasation events were successfully managed conservatively or with vasodilatory medications. Conclusions: Reports of the administration of vasopressors via PiVCs, when given for a limited duration, under close observation, suggest that extravasation is uncommon and is unlikely to lead to major complications.
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 [311]
Administration of vasopressors through peripheral IV catheters is generally safe.
“The administration of vasopressors through peripheral IV catheters is generally safe.”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [388]
A systematic review found extravasation occurred in 3.4% of patients with no reported tissue necrosis or limb ischaemia.
“A recent systematic review showed that extravasation occurred in 3.4% (95% CI 2.5–4.7%) of patients with no reported episodes of tissue necrosis or limb ischaemia [388].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [388]
Cites
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000100 · Cited by 28,164 · see citing works
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009) · Annals of Internal Medicine · doi:10.7326/0003-4819-151-4-200908180-00136 · Cited by 10,349 · see citing works
Early versus delayed administration of norepinephrine in patients with septic shock
Bai, X., Yu, W., Wu, J., Lin, Z., Tan, S., Duan, K., Dong, Y., Xu, L., & Li, N. (2014) · Critical Care · doi:10.1186/s13054-014-0532-y · Cited by 297 · see citing works
Loubani, O. M., & Green, R. S. (2015) · Journal of Critical Care · doi:10.1016/j.jcrc.2015.01.014 · Cited by 235 · see citing works
Safety of peripheral intravenous administration of vasoactive medication
Cardenas‐Garcia, J., Schaub, K. F., Belchikov, Y. G., Narasimhan, M., Koenig, S. J., & Mayo, P. H. (2015) · Journal of Hospital Medicine · doi:10.1002/jhm.2394 · Cited by 217 · see citing works
Timing of vasopressor initiation and mortality in septic shock: a cohort study
Beck, V., Chateau, D., Bryson, G. L., Pisipati, A., Zanotti, S., Parrillo, J. E., Kumar, A., & The Cooperative Antimicrobial Therapy of Septic Shock (CATSS) Database Research Group (2014) · Critical Care · doi:10.1186/cc13868 · Cited by 161 · see citing works
Interaction Between Fluids and Vasoactive Agents on Mortality in Septic Shock
Waechter, J. E., Kumar, A., Lapinsky, S. E., Marshall, J. C., Dodek, P., Arabi, Y. M., Parrillo, J. E., Dellinger, R. P., & Garland, A. (2014) · Critical Care Medicine · doi:10.1097/ccm.0000000000000520 · Cited by 149 · see citing works
Safety of the Peripheral Administration of Vasopressor Agents
Lewis, T. C., Merchan, C., Altshuler, D., & Papadopoulos, J. (2017) · Journal of Intensive Care Medicine · doi:10.1177/0885066616686035 · Cited by 146 · see citing works
Medlej, K., Kazzi, A. A. N., Chehadeh, A. A.-H., Eldine, M. S., Chami, A., Bachir, R. H., Zebian, D., & Dagher, G. A. (2017) · Journal of Emergency Medicine · doi:10.1016/j.jemermed.2017.09.007 · Cited by 105 · see citing works
Ricard, J.-D., Salomon, L., Boyer, A., Thiery, G., Meybeck, A., Roy, C., Pasquet, B., Le Mière, E., & Dreyfuss, D. (2013) · Critical Care Medicine · doi:10.1097/ccm.0b013e31828a42c5 · Cited by 104 · see citing works
Vasopressors and Inotropes in Sepsis
Stratton, L., Berlin, D., & Arbo, J. E. (2016) · Emergency Medicine Clinics of North America · doi:10.1016/j.emc.2016.09.005 · Cited by 56 · see citing works
Delgado, T., Wolfe, B. M., Davis, G. E., et al. (2016) · Journal of Critical Care · doi:10.1016/j.jcrc.2016.04.004 · Cited by 40 · see citing works
Datar, S. V., Gutierrez, E. J., Schertz, A. R., et al. (2017) · Journal of Intensive Care Medicine · doi:10.1177/0885066617712214 · Cited by 36 · see citing works
Vasopressor and Inotrope Use in Canadian Emergency Departments: Evidence Based Consensus Guidelines
Djogovic, D., MacDonald, S., Wensel, A., Green, R., Loubani, O. M., Archambault, P. M., Bordeleau, S., Messenger, D. W., Szulewski, A., Davidow, J., et al. (2015) · Canadian Journal of Emergency Medicine · doi:10.1017/cem.2014.77 · Cited by 30 · see citing works
Self-citationHeidemann, L. A., Nathani, N., Sagana, R. L., Chopra, V., & Heung, M. (2017) · Journal of Hospital Medicine · doi:10.12788/jhm.2784 · Cited by 30 · see citing works
Udy, A. A., Finnis, M., Jones, D., Delaney, A. P., Macdonald, S. P. J., Bellomo, R., & Peake, S. (2018) · Shock · doi:10.1097/shk.0000000000001281 · Cited by 28 · see citing works
Self-citationBallard, D. W., Reed, M., Rauchwerger, A. S., et al. (2014) · Academic Emergency Medicine · doi:10.1111/acem.12386 · Cited by 20 · see citing works
Kahn, C. B. (2014) · Journal of Emergency Medicine · doi:10.1016/j.jemermed.2014.10.022 · Cited by 14 · see citing works
(2000) · Time to knit · doi:10.1016/s0084-3873(14)00382-4 · Cited by 12 · see citing works
The Early History of Adrenaline
Ball, C. M., & Featherstone, P. J. (2017) · Anaesthesia and Intensive Care · doi:10.1177/0310057x1704500301 · Cited by 12 · see citing works
Management of Septic Shock in the Remote Prehospital Setting
Joynes, E., Martin, J., & Ross, M. (2016) · Air Medical Journal · doi:10.1016/j.amj.2016.04.001 · Cited by 10 · 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
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
Surviving Sepsis campaign: international guidelines for Management of Sepsis and Septic Shock 2026
Prescott, H. C., Antonelli, M., Alhazzani, W., Møller, M. H., Alshamsi, F., Azevedo, L. C. P., Belley-Cote, E., De Waele, J., Derde, L., Dionne, J. C., et al. (2026) · Critical Care Medicine · doi:10.1097/ccm.0000000000007075 · Cited by 117 · see citing works
Self-citationThe 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
- Authors
- Tian, D. H., Smyth, C., Keijzers, G., Macdonald, S. P., Peake, S., Udy, A., & Delaney, A.
- Affiliations
- Royal North Shore Hospital (AU)
- Griffith University (AU)
- The University of Western Australia (AU)
- Queen Elizabeth Hospital (AU)
- The Alfred Hospital (AU)
- The University of Sydney (AU)
- Corresponding author
- Tian, David H
- Venue
- Emergency Medicine Australasia
- Publisher
- Wiley
- Published
- 2019-11-07
- Volume
- 32
- Issue
- 2
- Pages
- 220-227
- ISSN
- 1035-6851 (ISSN-L)
- 1742-6731
- 1742-6723
- OpenAlex
- W2983935547
- Cited by
- 160
- References
- 21
- Citations by year
- 2026: 17 · 2025: 25 · 2024: 30 · 2023: 29 · 2022: 26 · 2021: 26 · 2020: 7
- FWCI
- 3.84
- Type
- journal article
- Language
- en
- Open access
- Licence
- Locations
- Emergency Medicine Australasia (publishedVersion)
- PubMed (publishedVersion)
- Bond University Research Portal (Bond University) (submittedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion, other-oa)
- Griffith Research Online (submittedVersion, other-oa)
- 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
- vasopressors, peripheral intravenous catheters, extravasation, norepinephrine, phenylephrine, dopamine, metaraminol, vasopressin, epinephrine, infusion safety, tissue necrosis, limb ischemia
- MeSH terms
- Adult, Catheterization, Peripheral, Humans, Hypotension, Prospective Studies, Retrospective Studies, Vasoconstrictor Agents
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
